MEDICARE - PHYSICAL THERAPIST IN INDEPENDENT PRACTICE REQUEST FOR CERTIFICATION

ICR 198903-0938-011

OMB: 0938-0258

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0258 198903-0938-011
Historical Active 198605-0938-009
HHS/CMS
MEDICARE - PHYSICAL THERAPIST IN INDEPENDENT PRACTICE REQUEST FOR CERTIFICATION
Revision of a currently approved collection   No
Regular
Approved without change 05/18/1989
Retrieve Notice of Action (NOA) 03/20/1989
  Inventory as of this Action Requested Previously Approved
05/31/1992 05/31/1992 07/31/1989
400 0 400
100 0 100
0 0 0

IN ORDER TO PARTICIPATE IN THE MEDICARE PROGRAM AS A PHYSICAL THERAPIS IN INDEPENDENT PRACTICE, IT IS REQUIRED THAT PROVIDERS OF THESE SERVICES MEET CERTAIN HEALTH AND SAFETY STANDARDS. THIS CERTIFICATION FORM IS UTILIZED BY STATE AGENCY SURVEYORS IN DETERMINING IF MINIMUM STANDARDS ARE MET.

None
None


No

1
IC Title Form No. Form Name
MEDICARE - PHYSICAL THERAPIST IN INDEPENDENT PRACTICE REQUEST FOR CERTIFICATION HCFA-262

  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 400 400 0 0 0 0
Annual Time Burden (Hours) 100 100 0 0 0 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.
03/20/1989


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