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Paperwork Burden Associated With Portable X-ray Survey And Request For Cert. As Portable X-ray Supplier Under The Medicare And/or Medicaid Program
PAPERWORK BURDEN ASSOCIATED WITH PORTABLE X-RAY SURVEY AND REQUEST FOR CERT. AS PORTABLE X-RAY SUPPLIER UNDER THE MEDICARE AND/OR MEDICAID PROGRAM
OMB: 0938-0027
IC ID: 112558
OMB.report
HHS/CMS
OMB 0938-0027
ICR 198212-0938-006
IC 112558
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0027 can be found here:
2021-08-13 - Revision of a currently approved collection
2018-03-28 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
PAPERWORK BURDEN ASSOCIATED WITH PORTABLE X-RAY SURVEY AND REQUEST FOR CERT. AS PORTABLE X-RAY SUPPLIER UNDER THE MEDICARE AND/OR MEDICAID PROGRAM
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.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HCFA-1880
No
No
Form
HCFA-R-14
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
138
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
138
0
0
0
0
138
Annual IC Time Burden (Hours)
736
0
0
0
0
736
Annual IC Cost Burden (Dollars)
0
0
0
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.