Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Registration Information Modified 2136 1068 0 Form CMS-855O
Initial Application Modified 45558 21262 0 Form CMS-855O
Reporting Voluntary Withdrawal of Registration Information Modified 6190 3095 0 Form and Instruction CMS-855O
Total burden requested under this ICR: 53884 25425 0  
To view an IC, click on IC Title