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Billing Forms Form Medicare/medicaid Hospice Demonstration

IC 112977 under ICR 198407-0938-002 · OMB 0938-0150.

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Information Collection (IC) Details

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BILLING FORMS FORM MEDICARE/MEDICAID HOSPICE DEMONSTRATION
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-245 No No
Form 246 No No


    

26 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved 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 1,260 0 0 1,260 0 0
Annual IC Time Burden (Hours) 8,970 0 0 8,970 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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