Medicare Enrollment Application (Initial Enrollment)

Medicare Enrollment Application for Clinics/Group Practices and Other Suppliers (CMS-855B)

OMB: 0938-1377

IC ID: 240711

Information Collection (IC) Details

View Information Collection (IC)

Medicare Enrollment Application (Initial Enrollment)
 
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-855B Enrollment Opioid Treatment Program CMS-855B - Enrollment OTP Application.pdf Yes No Fillable Fileable
Form and Instruction CMS-855B Medicare Enrollment Application with Opioid Treatment Program CMS-855B - Medicare Enrollment Application with Opioid Treatment Program - 30-day.pdf Yes No Fillable Fileable

Health Health Care Services

 

17,087 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 17,087 17,087 0 0 0 0
Annual IC Time Burden (Hours) 51,261 51,261 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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