Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Adding Information (New Business Data)	Removed	0	0	0	Form and Instruction	CMS-855S
Change of Enrollment Information	Modified	14117	14117	0	Form and Instruction	CMS-855(S)
Change of Enrollment Information	Modified	14117	14117	0	Form and Instruction	CMS-855-S
Initial Enrollment	Modified	6716	26864	0	Form and Instruction	CMS-855S
Initial Enrollment	Modified	6716	26864	0	Form and Instruction	CMS-855-S
Reactivation - Medicare Enrollment Application	Modified	2508	10032	0	Form and Instruction	CMS-855S
Revalidation of enrollment information	Modified	8099	16198	0	Form and Instruction	CMS-855S
Revalidation of enrollment information	Modified	8099	16198	0	Form and Instruction	CMS-855-S
Voluntary Withdrawing from Medicare	Modified	1350	675	0	Form and Instruction	CM-855S
Total burden requested under this ICR:		32790	67886	0
To view an IC, click on IC Title