Medicare Enrollment
Application for Institutional Providers (CMS-855A)
Revision of a currently approved collection
No
Regular
03/10/2021
Requested
Previously Approved
36 Months From Approved
12/31/2021
302,798
1,733,400
97,126
289,393
0
0
The primary function of the
(CMS-855A,B,I) Medicare enrollment application is to gather
information from a provider or supplier that tells us who it is,
whether it meets certain qualifications to be a health care
provider or supplier, where it practices or renders services, the
identity of the owners of the enrolling entity, and other
information necessary to establish correct claims
payments.
US Code:
42
USC 1395f Name of Law: Conditions of and Limitations on Payment
for Services
PL:
Pub.L. 105 - 33 4313 Name of Law: Provision of certain
identification numbers
PL:
Pub.L. 104 - 134 31001(I) Name of Law: Debt Collection
Improvement Act of 1996
US Code: 42
USC 1395g Name of Law: Payment to Providers of Services
US Code: 42
USC 1395m Name of Law: SPECIAL PAYMENT RULES FOR PARTICULAR
ITEMS AND SERVICES
US Code: 42
USC 1395cc Name of Law: AGREEMENTS WITH PROVIDERS OF SERVICES;
ENROLLMENT PROCESSES
US Code: 42
USC 1395l Name of Law: Payment of Benefits
US Code: 42
USC 1395u Name of Law: Provisions related to the Administration
of Part B
PL:
Pub.L. 111 - 148 6001 Name of Law: Affordable Care Act
The changes in this collection
of information request are associated with our December 28, 2020
(85 FR 84472) final rule (CMS-1734-F, RIN 0938-AU10). We are also
removing the requirements, burden, and applications associated with
CMS-855B (Medicare Enrollment Application for Clinics, Group
Practices, and Certain Other Suppliers) and CMS-855I (Medicare
Enrollment Application for Physicians and Non-Physician
Practitioners). Importantly, both of those forms remain active. To
avoid duplication, however, they are being removed from this
0938-0685 control number since they are now approved separately
under their own separate control numbers, namely: 0938-1377 for
CMS-855B and 0938-1355 for CMS-855I. Overall, the changes amount to
a reduction of 1,430,602 responses, 192,267 hours, and $17,144,125
(from $20,720,304 to $3,576,179). Please see section 15 of the
Supporting Statement for details.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form CMS-855A Medicare Enrollment Application for Institutional Providers
CMS-855ABI - Supporting Staement A (CMS-1734-F version 4).docx
Medicare Enrollment Application for Institutional Providers