INFORMATION COLLECTED FROM FISCAL INTERMEDIARIES AND CARRIERS - FINANCIAL COLLECTIONS CATEGORY

ICR 198403-0938-005

OMB: 0938-0351

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0351 198403-0938-005
Historical Active
HHS/CMS
INFORMATION COLLECTED FROM FISCAL INTERMEDIARIES AND CARRIERS - FINANCIAL COLLECTIONS CATEGORY
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/15/1984
Retrieve Notice of Action (NOA) 03/15/1984
THIS CLEARANCE REQUEST IS APPROVED WITH THE CONDITIONS OUTLINED IN JAMES B. MACRAE'S LETTER OF MAY 14, 1984.
  Inventory as of this Action Requested Previously Approved
11/30/1985 11/30/1985
103 0 0
1 0 0
0 0 0

FISCAL INTERMEDIARIES AND CARRIERS WHICH ADMINISTER THE MEDICARE PROGRAM UNDER CONTRACT TO HCFA MUST SUBMIT BUDGET AND EXPENDITURE INFORMATION TO HCFA SO THAT HCFA CAN DETERMINE ESTIMATED AND ACTUAL EXPENDITURES ASSOCIATED WITH ADMINISTRATION OF THE MEDICARE PROGRAM.

None
None


No

1
IC Title Form No. Form Name
INFORMATION COLLECTED FROM FISCAL INTERMEDIARIES AND CARRIERS - FINANCIAL COLLECTIONS CATEGORY

  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 103 0 0 103 0 0
Annual Time Burden (Hours) 1 0 0 1 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
03/15/1984


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