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Provider Reimbursement Manual, Part 1, Chapter 27, Sections 2721, 2722, And 2725. This Chapter Of The Prm Contains The Requirement For Submitting An Execption To Composite Rate

IC 113373 under ICR 198309-0938-007 · OMB 0938-0296.

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IC Title:	PROVIDER REIMBURSEMENT MANUAL, PART 1, CHAPTER 27, SECTIONS 2721, 2722, AND 2725. THIS CHAPTER OF THE PRM CONTAINS THE REQUIREMENT FOR SUBMITTING AN EXECPTION TO COMPOSITE RATE	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-R-9044				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	24,000	24,000
Annual IC Cost Burden (Dollars)	0	0

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