CMS-855S - Medicare Enrollment Application - Change Request

Non-Substantive Change Request:

OMB Control number 0939-1056

CMS-855S – Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S)

The following changes were submitted to OMB and approved on October 21, 2021. However, the incorrect version of the document was uploaded with the original submission. This non-substantive change request seeks to correct that oversight and place the correct version of the CMS-855S form on file.

Changes to the Form CMS-855S

2021 (old version)	January 2022 (new version)	Type of Change	Reason for Change	Burden Change
Included only Section 4. B.	Added: Section 4.B.2. 2. MEDICAL RECORD CORRESPONDENCE ADDRESS	Revision	This address was added due to an overwhelming request from the provider/supplier community via the Provider Compliance Group (CMS/PCG) to add a separate field to collect this specific information. MACs requested	No