Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Registration Information Modified 11200 5600 0 Form and Instruction CMS-855O Medicare Enrollment Application
Initial Application Modified 28000 14000 0 Form and Instruction CMS-855O Medicare Enrollment Application
Reporting Voluntary Withdrawal of Registration Information Modified 56000 14000 0 Form and Instruction CMS-855O Medicare Enrollment Application
Total burden requested under this ICR: 95200 33600 0  
To view an IC, click on IC Title