Change of Information Application

Medicare Enrollment Application for Eligible Ordering and Referring Physicians and Non-physician Practitioners- CMS 855O

OMB: 0938-1135

IC ID: 197862

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Change of Information Application
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-855(O) Medicare Enrollment Application - fOr EligiblE OrdEring and rEfErringPhySiCianS and nOn-PhySiCian PraCtitiOnErS CMS-855O(6-30-11).pdf Yes No Fillable Fileable

Health Health Care Services

 

8,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 8,000 8,000 0 0 0 0
Annual IC Time Burden (Hours) 6,000 6,000 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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