Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Enrollment Information New 55650 55650 0 Form and Instruction CMS-855B Medicare Enrollment Application with Opioid Treatment Program
Enrolling with a Administrative Contractor (MAC) New 37 74 0 Form and Instruction CMS-855B Medicare Enrollment Application with Opioid Treatment Program
Medicare Enrollment Application (Initial Enrollment) New 17087 51261 0 Form and Instruction CMS-855B Medicare Enrollment Application with Opioid Treatment Program
Form and Instruction CMS-855B Enrollment Opioid Treatment Program
Medicare Enrollment Application (Reactivation) New 1316 2632 0 Form and Instruction CMS-855B Medicare Enrollment Application with Opioid Treatment Plan
Medicare Enrollment Application - Revalidation New 31211 62422 0 Form and Instruction CMS-855B Medicare Enrollment Application with Opioid Treatment Program
Voluntarily Withdrawal (from the Medicare Program) New 3931 1966 0 Form and Instruction CMS-855B Medicare Enrollment Application with Opioid Treatment Program
Total burden requested under this ICR: 109232 174005 0  
To view an IC, click on IC Title