OMB control number
Medicare Enrollment Application for Clinics/ Group Practice and Certain Other Suppliers
OMB 0938-1198 · HHS/CMS.
OMB 0938-1198
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-855B Change of Information | Form and Instruction |
| Form CMS-855B Revalidation of Enrollment | Form and Instruction |
| Form CMS-855B Initial Enrollment | Form and Instruction |
 855B PECOS Screen Shots for PRA Package - 04192012.DOCX | Supplementary Document |
 CMS 855B - Revisons Spreadsheet - 04182012.xlsx | Supplementary Document |
| CMS 855B - section mapping - 04182012.xlsx | Supplementary Document |
| CMS-855B Supporting Statement.docx | Supporting Statement A |
 Change of Information |
Form and Instruction |
| Revalidation of Enrollment |
Form and Instruction |
| Initial Enrollment |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201302-0938-005 | New collection (Request for a new OMB Control Number) | 2013-02-12 | Approved without change |