CMS-855O Supporting Statement - u

To ensure uniform data submissions, CMS requires that all changes to previously submitted
enrollment data be reported via this enrollment application.
7. Special Circumstances
There are no special circumstances associated with this collection.
8. Federal Register Notice/Outside Consultation
No comments were received in response to the 60-day comment period December 11, 2015 (80 FR
76994). The Agency will publish a 30-day FR Notice.
9. Payment/Gift to Respondents
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10. Confidentiality
CMS will comply with all Privacy Act, Freedom of Information laws and regulations that apply
to this collection. Privileged or confidential commercial or financial information is protected
from public disclosure by Federal law 5 U.S.C. 522(b)(4) and Executive Order 12600.
11. Sensitive Questions
There are no sensitive questions associated with this collection.
12. Burden Estimate (hours and cost)
A. Burden Estimate (hours)
The currently approved total annual hour burden for the respondents for the CMS-8550 is
24, 125 hours. This estimate was calculated based on when/why a provider must complete and
submit the CMS-8550 application. The hours were determined as follows: 20,000 hours for
initial enrollment+ 4,000 hours for reporting changes of enrollment information+ 125 hours for
reporting a voluntary withdrawal of enrollment information.
For this proposed revision of the CMS-8550, CMS has recalculated the estimated burden hours.
CMS believes this recalculation is necessary because over the years of numerous revisions to this
data collection tool, the number of affected users, actual data collected and the collection
methods have changed significantly. CMS believes these new burden hours accurately reflect
the current burden for the purposes of this application when completing this proposed revision of

CMS 8550 = $21.60
56,000 respondents @ 0.25 hours each
$21.60 x 14,000 hours = $302,400
CMS estimates the new total burden cost for this information collection to be approximately
$7,328,160. These figures are calculated based on when/why a respondent must complete and
submit this enrollment application (CMS-8550). The figures are reflected below and in the
calculations in Part II of the 83 Worksheets.
The CMS-8550 is completed by the provider and its administrative staff. Ultimately,
completion and submission of the CMS-8550 by the provider is considered a routine business
function for the provider.
13. Cost to Respondents (Capital)
There are no capital costs associated with this collection.
14. Cost to Federal Government
Medicare contractors currently finalize approximately 1.3 million provider/supplier enrollment
applications a year. The form changes will not result in any additional cost to the federal
government because Medicare contractors are already processing applications from individuals
who are enrolling solely to prescribe Part D drugs. Applications will continue to be processed in
the normal course of Federal duties.
15. Changes in Burden/Program Changes
The burden increase is based the new burden amounts of data compiled from PECOS. The new
estimates for completing the CMS-8550 Medicare enrollment application form for initial
enrollment, reporting changes in enrollment information, and voluntarily withdrawal of
enrollment information are taken directly from the actual applications processed for calendar
year 2014 in PECOS. The new figures are exact and therefore more accurate than the prior
estimates. In addition, CMS assessed (via PECOS) how many providers are currently
prescribing based on their NPI and PDE data but are not currently enrolled in PECOS and
therefore will complete and submit the revised CMS-8550 as Part D drug prescribers. Those
assessed providers were added to the burden estimates.

CMS estimates the new total annual burden associated with this information collection is
approximately 243,600 hours.
16. Publication/Tabulation
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17. Expiration Date
We are planning on displaying the revision approval date and the expiration date.
18. Certification Statement
There are no exceptions to item 19 of OMB Form 83-1.

B. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS
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