MEDICARE-CLAIMS DEVELOPMENT DATA FROM BENEFICIARIES AND/OR SUPPLIERS & PROVIDERS, INTERMEDIARY MANUAL SECTIONS 3114, 3647, 3763, 3766, CARRIER MANUAL SECTIONS 2105, 2125, ETC.

ICR 198904-0938-025

OMB: 0938-0222

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0222 198904-0938-025
Historical Active 198703-0938-013
HHS/CMS
MEDICARE-CLAIMS DEVELOPMENT DATA FROM BENEFICIARIES AND/OR SUPPLIERS & PROVIDERS, INTERMEDIARY MANUAL SECTIONS 3114, 3647, 3763, 3766, CARRIER MANUAL SECTIONS 2105, 2125, ETC.
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/06/1989
Approved with change 04/06/1989
Retrieve Notice of Action (NOA) 04/06/1989
  Inventory as of this Action Requested Previously Approved
05/31/1990 05/31/1990 05/31/1990
5,600,000 0 5,600,000
933,333 0 933,333
0 0 0

THE INFORMATION DESCRIBED IN THESE MANUAL SECTIONS IS COLLECTED BY THE CONTRACTOR DURI THE REVIEW OF A CLAIM. THE INFORMATION IS NECESSARY BEFORE PROGRAM PAYMENT CAN BE MADE. REQUESTS FOR AUTHORIZATION FOR RELEASE OF INFORMATION. THIS INFORMATI IS REQUIRED BEFORE PROGRAM PAYMENT CAN BE MADE.

None
None


No

  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 5,600,000 5,600,000 0 0 0 0
Annual Time Burden (Hours) 933,333 933,333 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.
04/06/1989


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