Medicare Enrollment Application for Institutional Providers

Medicare Enrollment Application for Institutional Providers (CMS-855A)

OMB: 0938-0685

IC ID: 8284

Information Collection (IC) Details

View Information Collection (IC)

Medicare Enrollment Application for Institutional Providers
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-855A Medicare Enrollment Application - Institutional Providers CMS-855A [Sept 2021].pdf Yes No Fillable Fileable Signable

Health Health Care Services

 

40,133 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 302,798 0 -1,430,602 0 0 1,733,400
Annual IC Time Burden (Hours) 97,126 0 -192,267 0 0 289,393
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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