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Reporting Voluntary Withdrawal of Registration Information
Medicare Registration Application (CMS-855O)
OMB: 0938-1135
IC ID: 202856
OMB.report
HHS/CMS
OMB 0938-1135
ICR 202301-0938-008
IC 202856
( )
Documents and Forms
Document Name
Document Type
Form CMS-855O
Reporting Voluntary Withdrawal of Registration Information
Form and Instruction
CMS-855O Enrollment Application
CMS-855O - Medicare Registration Application.pdf
Form and Instruction
Information Collection (IC) Details
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