Medicare/medicaid The Lon Term Care Request For Certification

MEDICARE/MEDICAID THE LON TERM CARE REQUEST FOR CERTIFICATION

OMB: 0938-0478

IC ID: 113826

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MEDICARE/MEDICAID THE LON TERM CARE REQUEST FOR CERTIFICATION
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-1516 No No


    

19,100 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 19,100 0 0 19,100 0 0
Annual IC Time Burden (Hours) 4,775 0 0 4,775 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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