Request For Review Of Part B Medicare Claim

REQUEST FOR REVIEW OF PART B MEDICARE CLAIM

OMB: 0938-0033

IC ID: 166067

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Information Collection (IC) Details

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REQUEST FOR REVIEW OF PART B MEDICARE CLAIM
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-1964 No No


    

600,000 0
   
Private Sector Businesses or other for-profits
 
   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 600,000 0 0 550,000 0 50,000
Annual IC Time Burden (Hours) 150,000 0 0 137,500 0 12,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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