MEDICARE - ELECTION TO RECALCULATE MEDICARE REIMBURSEMENT BASED ON 42 CFR 405.457

ICR 198606-0938-002

OMB: 0938-0482

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0482 198606-0938-002
Historical Active
HHS/CMS
MEDICARE - ELECTION TO RECALCULATE MEDICARE REIMBURSEMENT BASED ON 42 CFR 405.457
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/14/1986
Retrieve Notice of Action (NOA) 06/19/1986
  Inventory as of this Action Requested Previously Approved
07/31/1988 07/31/1988
5,000 0 0
1,250 0 0
0 0 0

THIS IS A ONE-TIME-USE FORM PROVIDERS USE TO REQUEST THAT THEIR FISCAL INTERMEDIARIES REOPEN ONE OR MORE COS REPORTS SO THAT THE PROVISIONS OF 42 CFR 405.457, WHICH DEALS WITH MALPRACTICE INSURANCE PREMIUMS, MAY BE APPLIED RETROACTIVELY TO COST SETTLEMENTS.

None
None


No

1
IC Title Form No. Form Name
MEDICARE - ELECTION TO RECALCULATE MEDICARE REIMBURSEMENT BASED ON 42 CFR 405.457 HCFA-551-86

  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 5,000 0 0 5,000 0 0
Annual Time Burden (Hours) 1,250 0 0 1,250 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
06/19/1986


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