Information Collection
Reporting Voluntary Withdrawal of Registration Information
IC 202856 under ICR 202305-0938-019 · OMB 0938-1135.
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1135 can be found here:
Documents and Forms
| Document Name | Document Type |
|---|---|
Form CMS-855OReporting Voluntary Withdrawal of Registration Information |
Form and Instruction |
CMS-855O Enrollment ApplicationCMS-855O - Medicare Registration Application.pdf | Form and Instruction |
|
CMS-855O Enrollment Application CMS-855O - Medicare Registration Application.pdf | Form and Instruction |
Information Collection (IC) Details
| IC Title | Reporting Voluntary Withdrawal of Registration Information |
|---|