CONTRACTORS' INFORMATION COLLECTION - OVERPAYMENTS TO PROVIDERS, BENEFICIARIES, AND PHYSICIANS

ICR 198501-0938-001

OMB: 0938-0211

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0211 198501-0938-001
Historical Active 198310-0938-019
HHS/CMS
CONTRACTORS' INFORMATION COLLECTION - OVERPAYMENTS TO PROVIDERS, BENEFICIARIES, AND PHYSICIANS
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 01/25/1985
Retrieve Notice of Action (NOA) 01/24/1985
  Inventory as of this Action Requested Previously Approved
03/31/1985 03/31/1985
481,000 0 0
360,750 0 0
0 0 0

THIS INFORMATION IS USED TO COLLECT MONEY OVERPAID TO MEDICARE PROVIDERS, PHYSICIANS AND/OR BENEFICIARIES. IT IS REQUIRED THAT THESE FUNDS BE RETURNED TO THE MEDICARE TRUST FUND. THESE FORMS DEMAND REPAYMENT OF THE OVERPAYMENT AND IN SOME INSTANCES REQUIRE ADDITIONAL INFORMATION TO ASSURE THE OVERPAYMENT DETERMINATION IS ACCURATE.

None
None


No

1
IC Title Form No. Form Name
CONTRACTORS' INFORMATION COLLECTION - OVERPAYMENTS TO PROVIDERS, BENEFICIARIES, AND PHYSICIANS 9005

  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 481,000 0 0 0 481,000 0
Annual Time Burden (Hours) 360,750 0 0 0 360,750 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.
01/24/1985


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