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Voluntary Withdrawing from Medicare
Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S)
OMB: 0938-1056
IC ID: 243573
OMB.report
HHS/CMS
OMB 0938-1056
ICR 202309-0938-006
IC 243573
( )
Documents and Forms
Document Name
Document Type
Form CM-855S
Voluntary Withdrawing from Medicare
Form and Instruction
CM-855S Medicare Enrollment Application
CMS-855S Medicare Enrollment Application DMEPOS.pdf
Form and Instruction
Information Collection (IC) Details
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