REQUEST FOR INFORMATION - MEDICARE PAYMENTS FOR SERVICES TO A PATIENT NOW DECEASED

ICR 198705-0938-001

OMB: 0938-0020

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
0938-0020 198705-0938-001
Historical Active 198405-0938-013
HHS/CMS
REQUEST FOR INFORMATION - MEDICARE PAYMENTS FOR SERVICES TO A PATIENT NOW DECEASED
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 06/30/1987
Retrieve Notice of Action (NOA) 05/08/1987
  Inventory as of this Action Requested Previously Approved
06/30/1990 06/30/1990
300,000 0 0
75,000 0 0
0 0 0

THE HCFA-1660 IS USED IN PROCESSING PAID AND UNPAID BILLS FOR DECEASED MEDICATE BENEFICIARIES TO DETERMINE THE PROP PAYEE FOR MEDICARE BENEFITS WHICH MAY BE DUE.

None
None


No

1
IC Title Form No. Form Name
REQUEST FOR INFORMATION - MEDICARE PAYMENTS FOR SERVICES TO A PATIENT NOW DECEASED HCFA-1660

  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 300,000 0 0 0 300,000 0
Annual Time Burden (Hours) 75,000 0 0 0 75,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
05/08/1987


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