Medicare Participating Physician or Supplier Agreement

Medicare Participating Physician or Supplier Agreement (CMS-460)

Documents and Forms

Document Name Document Type
Form CMS-460 Medicare Participating Physician or Supplier Agreement Form and Instruction
CMS-460 Medicare Participating Provider or Supplier Agreement CMS-460.pdf Form and Instruction
CMS-460 Medicare Participating Provider or Supplier Agreement CMS-460.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Medicare Participating Physician or Supplier Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-460	Medicare Participating Provider or Supplier Agreement	CMS-460.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	36,000	7,000	29,000
Annual IC Time Burden (Hours)	9,000	1,750	7,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.