COST REPORT FORMS FOR GROUP PRACTICE PREPAYMENT PLANS WHICH DEAL DIRECTLY WITH HCFA

ICR 197905-0938-001

OMB: 0938-0038

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
0938-0038 197905-0938-001
Historical Active 197406-0938-001
HHS/CMS
COST REPORT FORMS FOR GROUP PRACTICE PREPAYMENT PLANS WHICH DEAL DIRECTLY WITH HCFA
Revision of a currently approved collection   No
Regular
Approved without change 06/22/1979
Retrieve Notice of Action (NOA) 05/30/1979
  Inventory as of this Action Requested Previously Approved
12/31/1983 12/31/1983 06/30/1979
27 0 200
1,080 0 800
0 0 0

USED BY GROUP PRACTICE PREPAYMENT PLANS TO REPORT ADMINISTRATIVE COSTS TO HCFA, FOR MEDICARE REIMBURSEMENT.

None
None


No

1
IC Title Form No. Form Name
COST REPORT FORMS FOR GROUP PRACTICE PREPAYMENT PLANS WHICH DEAL DIRECTLY WITH HCFA HCFA-2017

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 27 200 0 0 -173 0
Annual Time Burden (Hours) 1,080 800 0 0 280 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
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.
05/30/1979


© 2024 OMB.report | Privacy Policy