Information Collection

Medicare Participating Physician or Supplier Agreement

IC 8015 under ICR 202507-0938-010 · OMB 0938-0373.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-460 Medicare Participating Physician or Supplier Agreement	Form and Instruction
Form CMS-460 Medicare Participating Physician or Supplier Agreement Form Medicare Participating Physician or Supplier Agreement	Form and Instruction
CMS-460 Medicare Participating Physician or Supplier Agreement F CMS 460 Form.pdf	Form and Instruction
CMS-460 Medicare Participating Physician or Supplier Agreement F CMS 460 Form.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

CM-FFS

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-460				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,029

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	14,029	-21,971	36,000
Annual IC Time Burden (Hours)	3,507	-5,493	9,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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