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

OMB 0938-1056

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-855S Adding Information (New Business Data) Form and Instruction
Form CMS-855S Reactivation - Medicare Enrollment Application Form and Instruction
Form CM-855S Voluntary Withdrawing from Medicare Form and Instruction
Form CMS-855S Revalidation of enrollment information Form and Instruction
Form CMS-855(S) Change of Enrollment Information Form and Instruction
Form CMS-855S Initial Enrollment Form and Instruction
CMS-855S - Comment 60-day.docx Supplementary Document
CMS-855S - Supporting Statement.docx Supporting Statement A
CMS-855S - Crosswalk of Changes.xlsx Supplementary Document
Adding Information (New Business Data) Form and Instruction
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