Information Collection

Medicare - Information Collection Requirements In Hcfa-pub. 14-3 Carrier Manual Sections 2070.2, 3060.2.d., 4110.2 And 4110.4 - Physician/supplier Background Information

IC 113786 under ICR 198512-0938-005 · OMB 0938-0461.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0461 can be found here:

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Information Collection (IC) Details

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IC Title:	MEDICARE - INFORMATION COLLECTION REQUIREMENTS IN HCFA-PUB. 14-3 CARRIER MANUAL SECTIONS 2070.2, 3060.2.D., 4110.2 AND 4110.4 - PHYSICIAN/SUPPLIER BACKGROUND INFORMATION	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-R-89				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26,609	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	26,609	26,609
Annual IC Time Burden (Hours)	6,652	6,652
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.