Medicare Registration Application (CMS-855O)

ICR 202301-0938-008

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1135 can be found here:

Forms and Documents

Document Name	Status
Form CMS-855O Reporting Voluntary Withdrawal of Registration Information Form and Instruction	Modified
Form CMS-855O Change of Registration Information Form and Instruction	Modified
Form CMS-855O Initial Application Form and Instruction	Modified
CMS-855O - Supporting statement - 30-dayf.docx Supporting Statement A	2023-01-20

IC Document Collections

IC ID	Document Title	Status
202856	Reporting Voluntary Withdrawal of Registration Information Form and Instruction	Modified
197862	Change of Registration Information Form and Instruction	Modified
197861	Initial Application Form and Instruction	Modified

ICR Details