REVIEW OF OXYGEN CONCENTRATOR RENTAL CHARGES TO PART B OF THE MEDICARE PROGRAM

ICR 198606-0990-003

OMB: 0990-0165

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
0990-0165 198606-0990-003
Historical Active
HHS/HHSDM
REVIEW OF OXYGEN CONCENTRATOR RENTAL CHARGES TO PART B OF THE MEDICARE PROGRAM
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/16/1986
Retrieve Notice of Action (NOA) 06/20/1986
APPROVED WITH REVISION TO BENEFICIARY LETTER. NO SYSTEM OF RECORDS WI BE ESTABLISHED.
  Inventory as of this Action Requested Previously Approved
03/31/1987 03/31/1987
250 0 0
250 0 0
0 0 0

THIS REQUEST IS FOR COMPLETION OF A QUESTIONNAIRE ON 250 MEDICARE BENEFICIARIES IN ALABAMA TO EVALUATE THE MEDICAL NECESSIT AND ACTUAL UTILIZATION OF OXYGEN CONCENTRATES FOR WHICH RENTAL CHARGES ARE PAID BY PART B OF THE MEDICARE PROGRAM.

None
None


No

1
IC Title Form No. Form Name
REVIEW OF OXYGEN CONCENTRATOR RENTAL CHARGES TO PART B OF THE MEDICARE PROGRAM

  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 250 0 0 250 0 0
Annual Time Burden (Hours) 250 0 0 250 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.
06/20/1986


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