MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT

ICR 198407-0938-004

OMB: 0938-0373

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
113580 Migrated
ICR Details
0938-0373 198407-0938-004
Historical Active
HHS/CMS
MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/25/1984
Retrieve Notice of Action (NOA) 07/16/1984
  Inventory as of this Action Requested Previously Approved
08/31/1986 08/31/1986
272,880 0 0
43,661 0 0
0 0 0

THE HCFA-460 REQUIRES ALL PHYSICIANS/SUPPLIERS TO SELECT OR DECLINE PARTICIPATION IN MEDICARE. THESE TWO GROUPINGS ARE THE BASIS FOR UPDATING REASONABLE CHARGE SCREENS AND ANNUAL PUBLICATION OF A DIRECTORY OF PARTICIPATING PHYSICIANS AND SUPPLIERS. THOSE PHYSICIANS SUPPLIERS CHOOSING TO PARTICIPATE IN MEDICARE AGREE TO ACCEPT REIMBURSEMENT ON A REASONABLE CHARGE BASIS.

None
None


No

1
IC Title Form No. Form Name
MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT HCFA-460

  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 272,880 0 0 272,880 0 0
Annual Time Burden (Hours) 43,661 0 0 43,661 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.
07/16/1984


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