Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Adding Information (New Business Data)	Modified	1242	1242	0	Form and Instruction	CMS-855S
Change of Enrollment Information	Modified	12105	12105	0	Form and Instruction	CMS-855(S)
Change of Enrollment Information	Modified	12105	12105	0	Form and Instruction	CMS-855-S
Initial Enrollment	Modified	3429	13716	0	Form and Instruction	CMS-855S
Initial Enrollment	Modified	3429	13716	0	Form and Instruction	CMS-855-S
Reactivation - Medicare Enrollment Application	Modified	2376	9512	0	Form and Instruction	CMS-855S
Revalidation of enrollment information	Modified	25956	51912	0	Form and Instruction	CMS-855S
Revalidation of enrollment information	Modified	25956	51912	0	Form and Instruction	CMS-855-S
Voluntary Withdrawing from Medicare	Modified	7	4	0	Form and Instruction	CM-855S
Total burden requested under this ICR:		45115	88491	0
To view an IC, click on IC Title