PROVIDER BILLING FOR MEDICAL AND OTHER HEALTH SERVICES

ICR 198309-0938-012

OMB: 0938-0013

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
166042 Migrated
ICR Details
0938-0013 198309-0938-012
Historical Active 198304-0938-005
HHS/CMS
PROVIDER BILLING FOR MEDICAL AND OTHER HEALTH SERVICES
No material or nonsubstantive change to a currently approved collection   No
Emergency 09/30/1983
Approved with change 09/30/1983
Retrieve Notice of Action (NOA) 09/30/1983
  Inventory as of this Action Requested Previously Approved
05/31/1985 05/31/1985 05/31/1985
21,858,924 0 23,968,924
5,829,046 0 6,391,713
0 0 0

USED BY PROVIDERS TO CLAIM REIMBURSEMENT FOR OUTPATIENT SERVICES TO MEDICARE BENEFICIARIES. INTERMEDIARIES USE DATA TO DETERMINE INTERIM PAYMENTS TO PROVIDERS.

None
None


No

1
IC Title Form No. Form Name
PROVIDER BILLING FOR MEDICAL AND OTHER HEALTH SERVICES HCFA-1483

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 21,858,924 23,968,924 0 0 -2,110,000 0
Annual Time Burden (Hours) 5,829,046 6,391,713 0 0 -562,667 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/30/1983


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