Revalidation of enrollment information

Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S)

OMB: 0938-1056

IC ID: 197902

Information Collection (IC) Details

View Information Collection (IC)

Revalidation of enrollment information
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application CMS-855S - Enrollment Application.pdf Yes No Fillable Fileable
Form and Instruction CMS-855-S Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers CMS- 855S - DMEPOS Supplier PECOS Screen Shots - Word - 508.pdf Yes No Fillable Fileable

Health Health Care Services

 

25,956 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 25,956 0 0 4,364 21,592 0
Annual IC Time Burden (Hours) 51,912 0 0 35,718 16,194 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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