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Reporting Voluntary Withdrawal of Registration Information
Medicare Registration Application
CMS-855O.Screenshots
Reporting Voluntary Withdrawal of Registration Information
OMB: 0938-1135
OMB.report
HHS/CMS
OMB 0938-1135
ICR 201206-0938-005
IC 202856
Reporting Voluntary Withdrawal of Registration Information
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1135 can be found here:
2023-07-14 - Revision of a currently approved collection
2023-01-20 - Revision of a currently approved collection
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CMS
File Modified
0000-00-00
File Created
2021-01-30
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