Information Collection

Medicare-claims Developmt. Data From Benefic. &/or Suppliers & Provider, Intermed. Man. Sec. 3114,3647,3763,3766, Carrier Man. Sec. 2105,2125,3060,3300,3301, 10,000 & 12,000

IC 113155 under ICR 198703-0938-013 · OMB 0938-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0222 can be found here:

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Information Collection (IC) Details

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IC Title:	MEDICARE-CLAIMS DEVELOPMT. DATA FROM BENEFIC. &/OR SUPPLIERS & PROVIDER, INTERMED. MAN. SEC. 3114,3647,3763,3766, CARRIER MAN. SEC. 2105,2125,3060,3300,3301, 10,000 & 12,000	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA 9029				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,600,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,600,000	5,600,000
Annual IC Time Burden (Hours)	933,333	933,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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