MEDICARE CONTRACTOR ADMINISTRATIVE BUDGET AND COST REPORTING SYSTEM

ICR 198509-0938-011

OMB: 0938-0350

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
0938-0350 198509-0938-011
Historical Active 198403-0938-004
HHS/CMS
MEDICARE CONTRACTOR ADMINISTRATIVE BUDGET AND COST REPORTING SYSTEM
Revision of a currently approved collection   No
Regular
Approved without change 12/12/1985
Retrieve Notice of Action (NOA) 09/16/1985
  Inventory as of this Action Requested Previously Approved
01/31/1987 01/31/1987 11/30/1985
143 0 103
276,780 0 1
0 0 0

THE FORMS IN THIS SYSTEM ARE COMPLETED MONTHLY AND/OR ANNUALLY BY MEDICARE INTERMEDIARIES AND CARRIERS (CONTRACTORS). THE FORMS ARE SUBMITTED TO HCFA WHO USES THE INFORMATION TO REIMBURSE THE CONTRACTOR FOR ADMINISTRATIVE COST INCURRED AND TO PREPARE THE BUDGET FOR THE UPCOMING FISCAL YEAR.

None
None


No

1
IC Title Form No. Form Name
MEDICARE CONTRACTOR ADMINISTRATIVE BUDGET AND COST REPORTING SYSTEM HCFA-1523, 1524

  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 143 103 0 0 40 0
Annual Time Burden (Hours) 276,780 1 0 0 276,779 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.
09/16/1985


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