REQUEST FOR APPROVAL/ADVANCE APPROVAL AS A SUPPLIER OF ESRD SERVICES IN THE MEDICARE PROGRAM

ICR 197904-0938-001

OMB: 0938-0055

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0055 197904-0938-001
Historical Inactive 197608-0938-001
HHS/CMS
REQUEST FOR APPROVAL/ADVANCE APPROVAL AS A SUPPLIER OF ESRD SERVICES IN THE MEDICARE PROGRAM
Revision of a currently approved collection   No
Regular
Withdrawn and continue 05/21/1979
Retrieve Notice of Action (NOA) 04/04/1979
  Inventory as of this Action Requested Previously Approved
08/31/1981 05/21/1979 08/31/1981
1,000 0 1,000
366 0 366
0 0 0



None
None


No

1
IC Title Form No. Form Name
REQUEST FOR APPROVAL/ADVANCE APPROVAL AS A SUPPLIER OF ESRD SERVICES IN THE MEDICARE PROGRAM HCFA-3402,, HCFA-3403

No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/04/1979


© 2024 OMB.report | Privacy Policy