CONTRACTOR'S INFORMATION COLLECTIONS REASONABLE CHARGE/ REIMBURSEMENT

ICR 198501-0938-002

OMB: 0938-0206

Federal Form Document

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Name
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ICR Details
0938-0206 198501-0938-002
Historical Active 198402-0938-003
HHS/CMS
CONTRACTOR'S INFORMATION COLLECTIONS REASONABLE CHARGE/ REIMBURSEMENT
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
341,913 0 0
56,985 0 0
0 0 0

THESE CARRIER FORMS REQUEST: (1) ANNUAL PRICE LIST DATA FROM ALL LABS AND DURABLE MEDICAL EQUIPMENT SUPPLIERS AND (2) EQUITY ADJUSTMENT DATA FROM PHYSICIANS WHO PROTEST THEIR REASONABLE CHARGE FEES. THE INFORMATION IS USED TO UPDATE THE CARRIERS' REASONABLE CHARGE SCREENS.

None
None


No

1
IC Title Form No. Form Name
CONTRACTOR'S INFORMATION COLLECTIONS REASONABLE CHARGE/ REIMBURSEMENT 9008

  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 341,913 0 0 0 341,913 0
Annual Time Burden (Hours) 56,985 0 0 0 56,985 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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