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Form CMS-855-S Medicare Enrollment Application: Durable Medical Equipme
Medicare Enrollment Application (Form 855S)
855 PECOS Screen Shots for OSORA
Change of Enrollment Information
OMB: 0938-1056
OMB.report
HHS/CMS
OMB 0938-1056
ICR 201210-0938-010
IC 197901
Form CMS-855-S Medicare Enrollment Application: Durable Medical Equipme
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1056 can be found here:
2023-09-20 - Revision of a currently approved collection
2022-01-11 - No material or nonsubstantive change to a currently approved collection
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CMS
File Modified
0000-00-00
File Created
2021-01-30
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