CONTRACTORS' INFORMATION COLLECTIONS- CLAIMS DEVELOPMENT MIXTURE OF INSTITUTIONS

ICR 198112-0938-007

OMB: 0938-0227

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0227 198112-0938-007
Historical Active
HHS/CMS
CONTRACTORS' INFORMATION COLLECTIONS- CLAIMS DEVELOPMENT MIXTURE OF INSTITUTIONS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/21/1981
Retrieve Notice of Action (NOA) 12/01/1981
  Inventory as of this Action Requested Previously Approved
12/31/1983 12/31/1983
5,600,000 0 0
933,333 0 0
0 0 0

THE INFORMATION IS COLLECTED FROM A MIXTURE OF INSTITUTIONS, I.E., HOSPITALS, SNFS, HHAS, DURING THE CONTRACTOR'S REVIEW OF THE CLAIM. TYPES OF REQUESTED INFORMATION INCLUDE: RECORDS FROM PROVIDERS REGARDING DATE & TYPES OF SERVICE, CERTIFICATION OF THERAPY SERVICES, VERIFICATION OF DATE OF DEATH, EXPLANATION OF BILLING DELAY, ETC.

None
None


No

1
IC Title Form No. Form Name
CONTRACTORS' INFORMATION COLLECTIONS- CLAIMS DEVELOPMENT MIXTURE OF INSTITUTIONS HCFA-9027

  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 5,600,000 0 0 0 5,600,000 0
Annual Time Burden (Hours) 933,333 0 0 0 933,333 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.
12/01/1981


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