INPATIENT ADMISSION AND BILLING-CHRISTIAN SCIENCE SANATORIUM

ICR 198108-0938-002

OMB: 0938-0015

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
0938-0015 198108-0938-002
Historical Active 197803-0938-014
HHS/CMS
INPATIENT ADMISSION AND BILLING-CHRISTIAN SCIENCE SANATORIUM
Revision of a currently approved collection   No
Regular
Approved without change 09/15/1981
Retrieve Notice of Action (NOA) 08/12/1981
  Inventory as of this Action Requested Previously Approved
09/30/1984 09/30/1984 08/31/1981
4,700 0 4,700
1,566 0 1,566
0 0 0

INSTITUTION PROVIDER CLAIM FOR BENEFITS RENDERED TO MEDICARE BENEFICIARY IN A CHRISTIAN SCIENCE SANITORIUM. GENERATES INTERIM PAYMENT TO PROVIDERS AND DATA IS USED TO UPDATE MASTER UTILIZATION RECORDS.

None
None


No

1
IC Title Form No. Form Name
INPATIENT ADMISSION AND BILLING-CHRISTIAN SCIENCE SANATORIUM SSA-1486

  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 4,700 4,700 0 0 0 0
Annual Time Burden (Hours) 1,566 1,566 0 0 0 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.
08/12/1981


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