Initial Application

Medicare Registration Application (CMS-855O)

OMB: 0938-1135

IC ID: 197861

Information Collection (IC) Details

View Information Collection (IC)

Initial Application CPI - 855O
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-855O Enrollment Application CMS-855O - Medicare Registration Application.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

31,596 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   50 %

  Approved 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 31,596 0 0 -13,502 0 45,098
Annual IC Time Burden (Hours) 15,798 0 0 -6,751 0 22,549
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy