OMB control number

Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S)

OMB 0938-1056 · HHS/CMS.

OMB 0938-1056

The primary function of the CMS 855S Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier enrollment application is to gather information from a supplier that tells us who it is, whether it meets certain qualifications to be a health care supplier, where it renders its services or supplies, the identity of the owners of the enrolling entity, and information necessary to establish correct claims payment. The goal of this revision of the CMS 855S is to simplify and clarify the current data collection and to remove obsolete and/or redundant questions. Grammar and spelling errors were corrected. Limited informational text has been added within the application form and instructions in conjunction with links to websites when greater detail is needed by the supplier. To clarify current data collection differentiations and to be in sync with accreditation coding, Section 3D (“Products and Services Furnished by This Supplier”) has been updated. This revision does not offer any new material data collection.

The latest form for Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S) expires 2026-08-31 and is listed under ICR 202309-0938-006.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-855S Medicare Enrollment Application	Form and Instruction
Form CM-855S Medicare Enrollment Application	Form and Instruction
Form CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application	Form and Instruction
Form CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application	Form and Instruction
Form CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application	Form and Instruction
AAH PRA 855s Comments 1025.pdf (document unavailable)	Public Comments
Cochlear Comment 855S.pdf (document unavailable)	Public Comments
CMS-855S.Response to 60-day public comments.docx	Supplementary Document
CMS-855S - Supporting Statement.docx	Supporting Statement A
Reactivation - Medicare Enrollment Application	Form and Instruction
Voluntary Withdrawing from Medicare	Form and Instruction
Revalidation of enrollment information	Form and Instruction
Change of Enrollment Information	Form and Instruction
Initial Enrollment	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202511-0938-011	Revision of a currently approved collection	2025-11-21
202309-0938-006	Revision of a currently approved collection	2023-09-20	Approved without change
202201-0938-015	No material or nonsubstantive change to a currently approved collection	2022-01-11	Approved without change
202001-0938-004	Reinstatement without change of a previously approved collection	2020-09-14
201611-0938-010	Revision of a currently approved collection	2016-11-18	Approved with change
201610-0938-004	Revision of a currently approved collection	2016-10-20	Comment filed on proposed rule and continue
201512-0938-004	Revision of a currently approved collection	2015-12-22	Approved with change
201210-0938-010	Revision of a currently approved collection	2012-10-31	Approved with change
201105-0938-016	Revision of a currently approved collection	2011-05-31	Approved with change
200810-0938-001	New collection (Request for a new OMB Control Number)	2008-10-01	Approved with change

OMB Details

Initial Enrollment

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-855-S	Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers	Fillable Fileable	Form and instruction
Form CMS-855S	Medicare Durable Medical Equipment Supplier Enrollment Application	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.