PROVIDER CHAIN OPERATOR DATA

ICR 198107-0938-003

OMB: 0938-0039

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
112606 Migrated
ICR Details
0938-0039 198107-0938-003
Historical Inactive 198102-0938-020
HHS/CMS
PROVIDER CHAIN OPERATOR DATA
Reinstatement without change of a previously approved collection   No
Regular
Disapproved 09/01/1981
Retrieve Notice of Action (NOA) 07/06/1981
Not approved. This information, if needed, does not need to be collected via a separate or special survey such as proposed.
  Inventory as of this Action Requested Previously Approved
05/31/1981
0 0 0
0 0 0
0 0 0

THIS FORM ALLOWS HCFA TO IDENTIFY ALL PROVIDER FACILITIES WHICH ARE PART OF A CHAIN OPERATION AND ARE RECEIVING MEDICARE PAYMENTS. INFORMATION OBTAINED IS USED BY COST REPORT AND FRAUD INVESTIGATORS TO DETERMINE LEGITIMATE COST WRITE-OFFS.

None
None


No

1
IC Title Form No. Form Name
PROVIDER CHAIN OPERATOR DATA HCFA-1885A

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.
07/06/1981


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