Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Initial Enrollment Modified 188443 612440 0 Form and Instruction CMS-855i
Reactivation Modified 18053 36106 0 Form and Instruction CMS-855i
Reporting a Change Modified 485734 491924 0 Form and Instruction CMS-855i
Revalidation Modified 101890 203780 0 Form and Instruction CMS-855I
Switching Provider Type/MAC Modified 1088 2176 0 Form and Instruction CMS-855i
Voluntary Termination of Medicare Enrollment Modified 17767 8884 0 Form and Instruction CMS-855i
Total burden requested under this ICR: 812975 1355310 0  
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