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Form CMS-855O Enrollment Application
Medicare Registration Application (CMS-855O)
CMS-855O - Medicare Registration Application
Reporting Voluntary Withdrawal of Registration Information
OMB: 0938-1135
OMB.report
HHS/CMS
OMB 0938-1135
ICR 202301-0938-008
IC 202856
Form CMS-855O Enrollment Application
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1135 can be found here:
2023-07-14 - Revision of a currently approved collection
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