Medicare Enrollment Application (Reactivation)

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

OMB: 0938-1377

IC ID: 240710

Information Collection (IC) Details

View Information Collection (IC)

Medicare Enrollment Application (Reactivation)
 
No Unchanged
 
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 Plan CMS-855B - Medicare Enrollment Application with Opioid Treatment Program - 30-day.pdf Yes No Fillable Fileable

Health Health Care Services

 

1,316 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 1,316 0 0 0 0 1,316
Annual IC Time Burden (Hours) 2,632 0 0 0 0 2,632
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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