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REH Completion of CMS-855A Change of Information
Medicare Enrollment Application for Institutional Providers (CMS-855A)
OMB: 0938-0685
IC ID: 260074
OMB.report
HHS/CMS
OMB 0938-0685
ICR 202408-0938-001
IC 260074
( )
Documents and Forms
Document Name
Document Type
Form CMS-855A
REH Completion of CMS-855A Change of Information
Form and Instruction
CMS-855A Medicare Enrollment Application - Institutional Providers
CMS-855A- Medicare Enrollment Application Institutional Providers.pdf
Form and Instruction
Information Collection (IC) Details
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