Surety Bond Compliance

Medicare Enrollment Application (Form 855S)

OMB: 0938-1056

IC ID: 197903

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Surety Bond Compliance
 
No Removed
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-855(S) Medicare Durable Medical Equipment Supplier Enrollment Application CMS-855S(6-30-11).pdf Yes No Fillable Fileable

Health Health Care Services

 

59,323 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 0 0 -59,323 0 0 59,323
Annual IC Time Burden (Hours) 0 0 -177,969 0 0 177,969
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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