Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Enrollment Information Modified 14657 16254 0 Form and Instruction CMS-855S
Initial Enrollment Modified 10016 40826 0 Form and Instruction CMS-855S
Reactivation - Medicare Enrollment Application Modified 2508 11956 0 Form and Instruction CMS-855S
Revalidation of Enrollment Information Modified 8099 24946 0 Form and Instruction CMS-855S
Voluntary Withdrawing from Medicare Removed 0 0 0 Form and Instruction CM-855S
Total burden requested under this ICR: 35280 93982 0  
To view an IC, click on IC Title