Authorization And Invoice For Medical And Hospital Services

AUTHORIZATION AND INVOICE FOR MEDICAL AND HOSPITAL SERVICES

OMB: 2900-0339

IC ID: 147975

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AUTHORIZATION AND INVOICE FOR MEDICAL AND HOSPITAL SERVICES
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 10-7078 No No


    

252,000 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 252,000 0 0 0 0 252,000
Annual IC Time Burden (Hours) 10,080 0 -20 0 0 10,100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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