Information Collection Request

Medicare Federal Health Care Provider/Supplier Enrollment Application

ICR 200107-0938-015 · OMB 0938-0685 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
8281 Medicare Federal Health Care Provider/Supplier Enrollment Application Form Migrated

ICR Details

Reginfo record details
table that charts list comparision
  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





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Medicare Federal Health Care Provider/Supplier Enrollment Application HCFA-855A, HCFA-855B, HCFA-855I, HCFA-855R, HCFA-855S

table that charts list of burden
  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


Reginfo record details
  No