Information Collection

Provider Reimbursement Manual, Sections 2721, 2722, And 2725 Requests For Exception To End Stage Renal Disease Composite Rates, "medicare"

IC 113375 under ICR 198805-0938-005 · OMB 0938-0296.

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Information Collection (IC) Details

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IC Title:	PROVIDER REIMBURSEMENT MANUAL, SECTIONS 2721, 2722, AND 2725 REQUESTS FOR EXCEPTION TO END STAGE RENAL DISEASE COMPOSITE RATES, "MEDICARE"	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-9044				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150	75	75
Annual IC Time Burden (Hours)	7,200	3,600	3,600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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