Change of Enrollment Information

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

OMB: 0938-1377

IC ID: 240713

Information Collection (IC) Details

View Information Collection (IC)

Change of Enrollment Information
 
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 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

 

55,650 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 55,650 55,650 0 0 0 0
Annual IC Time Burden (Hours) 55,650 55,650 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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