Switching Provider Type/MAC

Medicare Enrollment Application for Physician and Non-Physician Practitioners; (CMS-855i)

OMB: 0938-1355

IC ID: 232320

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Switching Provider Type/MAC
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 424.500

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-855i Medicare Enrollment Application CMS-855I - Medicare Enrollment Application.docx Yes Yes Fillable Printable

Health Health Care Services

 

14,523 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 14,523 0 14,523 0 0 0
Annual IC Time Burden (Hours) 29,046 0 29,046 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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