Medicare and Other Federal Health Care Programs Provider/Supplier Enrollment Application

Medicare and Other Federal Health Care Programs Provider/Supplier Enrollment Application

OMB: 0938-0685

IC ID: 8278

Documents and Forms
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no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details

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Medicare and Other Federal Health Care Programs Provider/Supplier Enrollment Application
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-855 No No
Form HCFA-855S No No
Form HCFA-855C No No
Form HCFA-855R No No


    

225,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 225,000 0 60,000 0 0 165,000
Annual IC Time Burden (Hours) 435,000 0 65,000 0 0 370,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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