Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Initial Enrollment New 162977 488931 0 Form and Instruction CMS-855i
Reactivation New 16265 32530 0 Form and Instruction CMS-855i
Reporting a Change of Medicare Enrollment Information New 127416 127416 0 Form and Instruction CMS-855i
Revalidation New 150599 301198 0 Form and Instruction CMS-855I
Switching Provider Type/MAC New 14523 29046 0 Form and Instruction CMS-855i
Voluntary Termination of Medicare Enrollment New 42092 21046 0 Form and Instruction CMS-855i
Total burden requested under this ICR: 513872 1000167 0  
To view an IC, click on IC Title