Information Collection

Medicare Participating Physician or Supplier Agreement

IC 8015 under ICR 202507-0938-010 · OMB 0938-0373.

Documents and Forms

Document Name Document Type
Form CMS-460 Medicare Participating Physician or Supplier Agreement Form and Instruction
CMS-460 Medicare Participating Physician or Supplier Agreement F CMS 460 Form.pdf Form and Instruction
CMS-460 Medicare Participating Physician or Supplier Agreement F CMS 460 Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare Participating Physician or Supplier Agreement	Agency IC Tracking Number:	CM-FFS

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-460				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,029	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	14,029	-21,971	36,000
Annual IC Time Burden (Hours)	3,507	-5,493	9,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.