Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Medicare Enrollment Application for Institutional Providers Modified 217470 41120 0 Form and Instruction CMS-855A
REH Completion of CMS-855A Change of Information New 23 23 0 Form and Instruction CMS-855A
Total burden requested under this ICR: 217493 41143 0  
To view an IC, click on IC Title