MEDICARE MEDICARE INTERIM PAYMENT UPDATE REPORT

ICR 198512-0938-003

OMB: 0938-0180

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
113047 Migrated
ICR Details
0938-0180 198512-0938-003
Historical Active 198409-0938-020
HHS/CMS
MEDICARE MEDICARE INTERIM PAYMENT UPDATE REPORT
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 02/26/1986
Retrieve Notice of Action (NOA) 12/30/1985
  Inventory as of this Action Requested Previously Approved
02/28/1989 02/28/1989
14,000 0 0
224,000 0 0
0 0 0

THE MEDICARE INTERIM PAYMENT UPDATE REPORT, HCFA-91, IS USED TO COLLEC INFORMATION FROM PROVIDERS TO ENABLE INTERMEDIARIES TO EVALUATE THE REASONABLENESS OF THE LEVEL OF INTERIM PAYMENTS MADE TO PROVIDERS. AS REVISED, THE HCFA-91 COLLECTS INTERIM PAYMENT DATA FROM HOSPITALS, SNF'S AS BEFORE AND INCLUDES THE ADDITION OF HHA'S AND CORF'S.

None
None


No

1
IC Title Form No. Form Name
MEDICARE MEDICARE INTERIM PAYMENT UPDATE REPORT HCFA-0091

  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 14,000 0 0 0 14,000 0
Annual Time Burden (Hours) 224,000 0 0 0 224,000 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.
12/30/1985


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