Information Collection Request
Medicare Registration Application (CMS-855O)
ICR 202301-0938-008 · OMB 0938-1135 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1135 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-855O Reporting Voluntary Withdrawal of Registration Information |
Form and Instruction | Modified | Repair queued |
| Form CMS-855O Change of Registration Information |
Form and Instruction | Modified | Repair queued |
| Form CMS-855O Initial Application |
Form and Instruction | Modified | Repair queued |
 CMS-855O - Supporting statement - 30-dayf.docx |
Supporting Statement A | Uploaded 2023-01-20 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 202856 |  Reporting Voluntary Withdrawal of Registration Information |
Form and Instruction | Modified | |
| 197862 | Change of Registration Information |
Form and Instruction | Modified | |
| 197861 | Initial Application |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1135 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202201-0938-006 |
| Agency Tracking No | CPI |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |