Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Registration Information Modified 2250 1125 0 Form and Instruction CMS-855O Enrollment Application
Initial Application Modified 31596 15798 0 Form and Instruction CMS-855O Enrollment Application
Reporting Voluntary Withdrawal of Registration Information Modified 6190 3095 0 Form and Instruction CMS-855O Enrollment Application
Total burden requested under this ICR: 40036 20018 0  
To view an IC, click on IC Title