Information Collection

Request For Medicare Payment By Organizations Which Qualify To Receive Payment For Paid Bills

IC 166027 under ICR 198204-0938-018 · OMB 0938-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0008 can be found here:

Documents and Forms

Document Name Document Type

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Information Collection (IC) Details

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IC Title:	REQUEST FOR MEDICARE PAYMENT BY ORGANIZATIONS WHICH QUALIFY TO RECEIVE PAYMENT FOR PAID BILLS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-1500	No	No
Form	1490-S	No	No
Form	1490-U	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,850,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	97,619,744	-23,380,256	121,000,000
Annual IC Time Burden (Hours)	24,404,936	9,138,269	15,266,667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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