Information Collection

Group Practice Prepayment Plans - Special Administrative Cost Report, Quarterly Invoice Of And Final Special Administrative Costs

IC 113011 under ICR 198104-0938-002 · OMB 0938-0164.

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Information Collection (IC) Details

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IC Title:	GROUP PRACTICE PREPAYMENT PLANS - SPECIAL ADMINISTRATIVE COST REPORT, QUARTERLY INVOICE OF AND FINAL SPECIAL ADMINISTRATIVE COSTS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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	239, & 240				No	No
Form	HCFA-238,				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	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
Annual Number of Responses for this IC	330	330
Annual IC Time Burden (Hours)	3,080	3,080
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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