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Federal forms, ICRs, and supporting documents

Information Collection

Request For Medicare Payment By Mmhd Facility

IC 112956 under ICR 198203-0938-003 · OMB 0938-0145.

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Information Collection (IC) Details

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REQUEST FOR MEDICARE PAYMENT BY MMHD FACILITY
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-237 No No


    

30,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30,000 0 0 0 0 30,000
Annual IC Time Burden (Hours) 6,000 0 0 0 0 6,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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