Information Collection

Claims Data Collected From Physicians And Other Health Care Providers--home Blood Glucose Monitors--hcfa-pub. 13-3 And 14-3

IC 113193 under ICR 198212-0938-008 · OMB 0938-0233.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0233 can be found here:

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Information Collection (IC) Details

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IC Title:	CLAIMS DATA COLLECTED FROM PHYSICIANS AND OTHER HEALTH CARE PROVIDERS--HOME BLOOD GLUCOSE MONITORS--HCFA-PUB. 13-3 AND 14-3	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-9023				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 295,000	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,602,000	2,000	5,600,000
Annual IC Time Burden (Hours)	933,833	500	933,333
Annual IC Cost Burden (Dollars)	0	0	0

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Title	Document	Date Uploaded

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