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Attending Physician's Certification Of Medical Necessity For The Home Oxygen
ATTENDING PHYSICIAN'S CERTIFICATION OF MEDICAL NECESSITY FOR THE HOME OXYGEN
OMB: 0938-0422
IC ID: 113687
OMB.report
HHS/CMS
OMB 0938-0422
ICR 198803-0938-004
IC 113687
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0422 can be found here:
1988-11-22 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
ATTENDING PHYSICIAN'S CERTIFICATION OF MEDICAL NECESSITY FOR THE HOME OXYGEN
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-484
No
No
Form
HCFA-R-60
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
1
0
0
1
0
0
Annual IC Time Burden (Hours)
24,930
0
0
24,930
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.