Medicare Federal Health Care Provider/Supplier Enrollment Application

ICR 200107-0938-015

OMB: 0938-0685

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0685 200107-0938-015
Historical Active 199807-0938-005
HHS/CMS
Medicare Federal Health Care Provider/Supplier Enrollment Application
Revision of a currently approved collection   No
Regular
Approved without change 09/25/2001
Retrieve Notice of Action (NOA) 07/27/2001
OMB approves these revised forms (see attached CMS response) through 1/2002 under the firm condition that in the next few months, they are republished and opened for public comment along with the proposed rules governing provider enrollment. In addition, with the exception of the flexible 90-day schedule for updates, CMS must revise these forms and instructions to ensure that the scope, frequency, and general administration of these forms does not change from previously approved policy. OMB believes that it would have been most beneficial to initially release these forms with proposed rule so that the public could review all of CMS' enrollment policies as a comprehensive package. The rulemakings ultimately will have implications for the burden and practical utility of these forms. However to date, HHS has not submitted the enrollment rules for OMB review pursuant to E.O. No. 12866 review. In addition, the provider enrollment rules must be subjected to full public comment and entire rulemaking process affroded by the APA. The full rulemaking process (from proposed to final rulemaking) typically takes at least a year to complete. In the meantime, these revised forms can provide preliminary burden relief to the industry and respond to numerous concerns expressed in the town meetings at the end of the last Administration. Therefore, OMB approves these forms for short term use but expects to consider all amendments suggested in the context of the future enrollment rulemakings.
  Inventory as of this Action Requested Previously Approved
02/28/2002 02/28/2002 09/30/2001
604,000 0 225,000
435,000 0 435,000
0 0 0

This information is needed to enroll providers and suppliers into the Medicare program by identifying them, and verifying their qualifications and eligibility to participate in Medicare, and to price and pay their claims. The current HCFA 855 and its iterations are being revised for simplicity and clarity.

None
None


No

1
IC Title Form No. Form Name
Medicare Federal Health Care Provider/Supplier Enrollment Application HCFA-855A, HCFA-855B, HCFA-855I, HCFA-855R, HCFA-855S

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 604,000 225,000 0 379,000 0 0
Annual Time Burden (Hours) 435,000 435,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/27/2001


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