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 45822 22911 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: 54262 27131 0  
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