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Federal forms, ICRs, and supporting documents

Information Collection Request

Medicare Participating Physician or Supplier Agreement (CMS-460)

ICR 202507-0938-010 · OMB 0938-0373 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-460 Medicare Participating Physician or Supplier Agreement Form Form and Instruction Modified Available
Form CMS-460 Medicare Participating Physician or Supplier Agreement Form and Instruction Modified Missing upstream
CMS-460.Supporting Statement Part A.docx Supporting Statement A Uploaded 2025-07-08 Available
CMS-460.Supporting Statement Part A.docx Supporting Statement A Uploaded 2025-07-08 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
8015 Medicare Participating Physician or Supplier Agreement Form and Instruction ModifiedMedicare Participating Physician or Supplier Agreement Form
8015 Medicare Participating Physician or Supplier Agreement Form and Instruction Modified
ICR Details
0938-0373 202507-0938-010
Active 202207-0938-006
HHS/CMS CM-FFS
Medicare Participating Physician or Supplier Agreement (CMS-460)
Extension without change of a currently approved collection   No
Regular
Approved without change 12/18/2025
Retrieve Notice of Action (NOA) 07/11/2025
  Inventory as of this Action Requested Previously Approved
12/31/2028 36 Months From Approved 12/31/2025
14,029 0 36,000
3,507 0 9,000
0 0 0
The CMS-460 is completed by nonparticipating physicians and suppliers if they choose to participate in Medicare Part B. By signing the agreement, the physician or supplier agrees to take assignment on all Medicare claims. To take assignment means to accept the Medicare allowed amount as payment in full for the services they furnish and to charge the beneficiary no more than the deductible and coinsurance for the covered service. In exchange for signing the agreement, the physician or supplier receives a signficiant number of program benefits not available to nonparticipating suppliers. The information associated with this collection is needed to identify the recipients of the program benefits.
PL: Pub.L. 98 - 369 a Name of Law: The Deficit Reduction Act of 1984
  
None
Not associated with rulemaking
  90 FR 16685 04/21/2025
90 FR 29550 07/03/2025
No
1
IC Title Form No. Form Name
Medicare Participating Physician or Supplier Agreement CMS-460 Medicare Participating Physician or Supplier Agreement Form
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 14,029 36,000 0 -21,971 0 0
Annual Time Burden (Hours) 3,507 9,000 0 -5,493 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
Cost burden is reduced due to a decreased number of respondents.
$188,370
No
    No
    No
No
No
No
No
Malcolm Wilson 667 414-0087 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/11/2025