Information Collection
Medicare Enrollment Application for Institutional Providers
IC 8284 under ICR 202305-0938-003 · OMB 0938-0685.
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0685 can be found here:
Documents and Forms
| Document Name | Document Type |
|---|---|
Form CMS-855AMedicare Enrollment Application for Institutional Providers |
Form and Instruction |
CMS-855A Medicare Enrollment Application - Institutional ProviderCMS-855A (Medicare Enrollment Application - Institutional Providers).pdf | Form and Instruction |
|
CMS-855A Medicare Enrollment Application - Institutional Provider CMS-855A-(Medicare Enrollment Application - Institutional Providers ).pdf | Form and Instruction |
Information Collection (IC) Details
| IC Title | Medicare Enrollment Application for Institutional Providers |
|---|