Information Collection

Medicare Program Carrier Performance Report

IC 113652 under ICR 198802-0938-008 · OMB 0938-0399.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0399 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	MEDICARE PROGRAM CARRIER PERFORMANCE REPORT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	660	63	597
Annual IC Time Burden (Hours)	1,460	140	1,320
Annual IC Cost Burden (Dollars)	0	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.