CONTRACTORS INFORMATION COLLECTIONS - "CLAIMS DEVELOPMENT SKILLED NURSING FACILITIES"

ICR 198506-0938-002

OMB: 0938-0223

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0223 198506-0938-002
Historical Active 198501-0938-006
HHS/CMS
CONTRACTORS INFORMATION COLLECTIONS - "CLAIMS DEVELOPMENT SKILLED NURSING FACILITIES"
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 07/11/1985
Retrieve Notice of Action (NOA) 06/24/1985
  Inventory as of this Action Requested Previously Approved
12/31/1987 12/31/1987
3,100 0 0
16,666 0 0
0 0 0

THESE FORMS ARE SENT BY FISCAL INTERMEDIARIES TO SKILLED NURSING FACILITIES REIMBURSED BY MEDICARE. THE FORMS REQUEST MEDICAL REVIEW INFORMATION FOR PROCESSING CLAIMS.

None
None


No

1
IC Title Form No. Form Name
CONTRACTORS INFORMATION COLLECTIONS - "CLAIMS DEVELOPMENT SKILLED NURSING FACILITIES" HCFA 9031

  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 3,100 0 0 0 3,100 0
Annual Time Burden (Hours) 16,666 0 0 0 16,666 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.
06/24/1985


© 2024 OMB.report | Privacy Policy