Information Collection

Provider Reimbursement Manual, Sections 2721, 2722, And 2725 Requests For Exception To End State Renal Disease Composite Rates

IC 113374 under ICR 198505-0938-006 · OMB 0938-0296.

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Information Collection (IC) Details

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IC Title:	PROVIDER REIMBURSEMENT MANUAL, SECTIONS 2721, 2722, AND 2725 REQUESTS FOR EXCEPTION TO END STATE RENAL DISEASE COMPOSITE RATES	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-9044				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	3,600	3,600
Annual IC Cost Burden (Dollars)	0	0

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