Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Currently Enrolled via CMS-855O now Enrolling as Individual Supplier New 6190 12545 0 Form and Instruction CMS-855I
Initial Enrollment Modified 188443 617460 0 Form and Instruction CMS-855I
Reactivation Modified 18053 36587 0 Form and Instruction CMS-855I
Reporting a Change Modified 480544 480544 0 Form and Instruction CMS-855I
Revalidation Modified 101890 206494 0 Form and Instruction CMS-855I
Switching Provider Type/MAC Modified 1088 2205 0 Form and Instruction CMS-855I
Voluntary Termination of Medicare Enrollment Modified 17767 8884 0 Form and Instruction CMS-855I
Total burden requested under this ICR: 813975 1364719 0  
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