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Medicare Enrollment Application for Institutional Providers (CMS-855A)
ICR 202305-0938-003
OMB: 0938-0685
Federal Form Document
OMB.report
HHS/CMS
OMB 0938-0685
ICR 202305-0938-003
( )
Forms and Documents
Document
Name
Status
Form CMS-855A Medicare Enrollment Application for Institutional Providers
Form and Instruction
Modified
Form CMS-855A REH Completion of CMS-855A Change of Information
Form and Instruction
New
CMS-855A - Responses to 60-day comments.docx
Supplementary Document
2023-05-05
CMS-855A - Crosswalk Revisions Spreadsheet.xlsx
Supplementary Document
2023-05-05
CMS-855A - Supporting Statement Part A (30-day).docx
Supporting Statement A
2023-05-05
IC Document Collections
IC ID
Document
Title
Status
8284
Medicare Enrollment Application for Institutional Providers
Form and Instruction
Modified
260074
REH Completion of CMS-855A Change of Information
Form and Instruction
New
ICR Details
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