Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Enrollment Information Modified 14657 14657 0 Form and Instruction CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application
Initial Enrollment Modified 10016 40064 0 Form and Instruction CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application
Reactivation - Medicare Enrollment Application Modified 2508 10032 0 Form and Instruction CMS-855S Medicare Enrollment Application
Revalidation of enrollment information Modified 8099 16198 0 Form and Instruction CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application
Voluntary Withdrawing from Medicare Removed 0 0 0 Form and Instruction CM-855S Medicare Enrollment Application
Total burden requested under this ICR: 35280 80951 0  
To view an IC, click on IC Title