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Medicare Request For Approval As A Supplier Of Esrd Services In The Medicare Program

IC 112679 under ICR 198909-0938-003 · OMB 0938-0055.

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MEDICARE REQUEST FOR APPROVAL AS A SUPPLIER OF ESRD SERVICES IN THE MEDICARE PROGRAM
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-3402 No No


    

800 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved 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 800 0 0 800 0 0
Annual IC Time Burden (Hours) 133 0 0 133 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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