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Information Collection

Billing Form For The Alcoholism Services Coverage Demonstration

IC 113282 under ICR 198504-0938-002 · OMB 0938-0259.

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Information Collection (IC) Details

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BILLING FORM FOR THE ALCOHOLISM SERVICES COVERAGE 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-1480A No No


    

110 0
   
Private Sector Businesses or other for-profits
 
   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 45,000 0 0 0 0 45,000
Annual IC Time Burden (Hours) 6,000 0 0 0 0 6,000
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.