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Medicare Esrd Outcome Survey Report Form

IC 113870 under ICR 198611-0938-001 · OMB 0938-0492.

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MEDICARE ESRD OUTCOME SURVEY REPORT FORM
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA 3427 No No
Form (TEST) No No


    

53 0
   
State, Local, and Tribal Governments
 
   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 165 0 165 0 0 0
Annual IC Time Burden (Hours) 330 0 330 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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