Approved for one
year since CMS has advised that this collection will be revised in
January. The approval currently extends only to the mode of
collection (paper based form) contained in this request.
Inventory as of this Action
Requested
Previously Approved
07/31/2012
36 Months From Approved
01/31/2012
429,450
0
400,000
856,395
0
785,702
0
0
0
CMS is revising the CMS-855 Medicare
Enrollment Applications Package (OMB No. 0938-0685) to remove the
CMS-855S application from its collection. CMS has found that the
regulations governing the standards required of suppliers of
durable medical equipment, prosthetics, orthotics and supplies
(DMEPOS) are revised and increased more frequently than the other
provider types reimbursed by Medicare. The ability to revise the
CMS 855S separately from the other CMS 855 enrollment applications
will lessen the burden on both CMS and OMB as well as the public
during the Federal Register notice period, as only one subset of
suppliers will be effected by CMS 855S revisions.
PL:
Pub.L. 104 - 134 31001(I) Name of Law: Debt Collection
Improvement Act of 1996
US Code: 42
USC 1395f Name of Law: Conditions of and Limitations on Payment
for Services
PL:
Pub.L. 105 - 33 4313 Name of Law: Provision of certain
identification numbers
US Code: 42
USC 1395g Name of Law: Payment to Providers of Services
US Code: 42
USC 1395l Name of Law: Payment of Benefits
US Code: 42
USC 1395u Name of Law: Provisions related to the Administration
of Part B
US Code: 42
USC 1395m Name of Law: SPECIAL PAYMENT RULES FOR PARTICULAR
ITEMS AND SERVICES
US Code: 42
USC 1395cc Name of Law: AGREEMENTS WITH PROVIDERS OF SERVICES;
ENROLLMENT PROCESSES
The currently approved total
annual hour burden for respondents to the CMS-855A, CMS-855B,
CMS-855I and CMS-855R is 785,702.3 hours. As outlined above, we
estimate that the changes described in section 12 of this document
will add 70,693 hours to this burden at a cost of $7,744,860.
Therefore, the total hour burden for the respondents to the
CMS-855A, CMS-855B, CMS-855I and CMS-855R is 856,395.3 hours. The
group/clinic and individual burden has decreased due to the removal
of a previously proposed supplier attachment. However, the overall
burden hour estimate has increased slightly due to additional
role-specific ownership and managerial control data collection for
institutional providers.
$0
No
No
Yes
No
No
Uncollected
William Parham
4107864669
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.
Form CMS-855B Medicare Enrollment Application
CMS-855(A,B,I,R). Response to Public Comments (06282011).doc
Medicare Enrollment Application