Plan Of Treatment And Home Health Certification Form, Medical Information Form, Addendum To The Pot And Mif For, And Intermediary Medical Information Request

PLAN OF TREATMENT AND HOME HEALTH CERTIFICATION FORM, MEDICAL INFORMATION FORM, ADDENDUM TO THE POT AND MIF FOR, AND INTERMEDIARY MEDICAL INFORMATION REQUEST

OMB: 0938-0357

IC ID: 113518

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PLAN OF TREATMENT AND HOME HEALTH CERTIFICATION FORM, MEDICAL INFORMATION FORM, ADDENDUM TO THE POT AND MIF FOR, AND INTERMEDIARY MEDICAL INFORMATION REQUEST
 
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-485, No No
Form 486, 487, No No
Form 488 No No


    

5,320 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 2,654,386 0 0 2,654,386 0 0
Annual IC Time Burden (Hours) 1,216,599 0 0 1,216,599 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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