PROVIDER OVERPAYMENT REPORT

ICR 198903-0938-003

OMB: 0938-0441

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
113732 Migrated
ICR Details
0938-0441 198903-0938-003
Historical Active 198507-0938-001
HHS/CMS
PROVIDER OVERPAYMENT REPORT
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 05/04/1989
Retrieve Notice of Action (NOA) 03/06/1989
  Inventory as of this Action Requested Previously Approved
05/31/1992 05/31/1992
65 0 0
3,250 0 0
0 0 0

THIS REPORT IS COMPLETED DAILY BY MEDICARE INTERMEDIARIES AND SUBMITTED TO HCFA. IT LISTS PROVIDER OVERPAYMENT INFORMATION AND SHOWS WHETHER OR NOT AN INTERMEDIARY IS TAKING PROMPT AND AGRESSIVE ACTION TO RECOVER SUCH OVERPAYMENTS, IN ACCORDANCE WITH APPLICABLE LAW AND REGULATIONS. OMB APPROVAL.

None
None


No

1
IC Title Form No. Form Name
PROVIDER OVERPAYMENT REPORT HCFA-481

  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 65 0 0 0 65 0
Annual Time Burden (Hours) 3,250 0 0 0 3,250 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.
03/06/1989


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