CONTRACTORS' INFORMATION COLLECTIONS - CARRIERS' EXTERNAL AUDIT OF SERVICES PROVIDED TO BENEFICIARIES

ICR 198112-0938-015

OMB: 0938-0232

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0232 198112-0938-015
Historical Active
HHS/CMS
CONTRACTORS' INFORMATION COLLECTIONS - CARRIERS' EXTERNAL AUDIT OF SERVICES PROVIDED TO BENEFICIARIES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/19/1981
Retrieve Notice of Action (NOA) 12/04/1981
  Inventory as of this Action Requested Previously Approved
04/30/1983 04/30/1983
170,000 0 0
28,333 0 0
0 0 0

MEDICARE CARRIERS ARE REQUIRED TO CONDUCT EXTERNAL AUDITS WITH MEDICARE BENEFICIARIES TO CONFIRM SERVICES RENDERED BY PHYSICIANS AND OTHER HEALTH CARE SUPPLIERS. THE BENEFICIARIES ARE ASKED TO IDENTIFY DISCREPANCIES BETWEEN SERVICES RENDERED AND BILLED, AND THE AMOUNT CHARGED FOR COINSURANCE.

None
None


No

1
IC Title Form No. Form Name
CONTRACTORS' INFORMATION COLLECTIONS - CARRIERS' EXTERNAL AUDIT OF SERVICES PROVIDED TO BENEFICIARIES HCFA-9039

  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 170,000 0 0 0 170,000 0
Annual Time Burden (Hours) 28,333 0 0 0 28,333 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.
12/04/1981


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