OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medicare Enrollment Application (Reactivation)

IC 240710 under ICR 202011-0938-012 · OMB 0938-1377.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Medicare Enrollment Application (Reactivation)
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
42 CFR 424.500

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-855B Medicare Enrollment Application with Opioid Treatment Plan CMS-855B - Medicare Enrollment Application with Opioid Treatment Program - 30-day.pdf Yes No Fillable Fileable

Health Health Care Services

 

1,316 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,316 0 0 0 0 1,316
Annual IC Time Burden (Hours) 2,632 0 0 0 0 2,632
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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