MEDICARE - PRO REPORTING FORMS

ICR 199001-0938-006

OMB: 0938-0531

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
113931 Migrated
ICR Details
0938-0531 199001-0938-006
Historical Active 198807-0938-006
HHS/CMS
MEDICARE - PRO REPORTING FORMS
Revision of a currently approved collection   No
Regular
Approved without change 04/24/1990
Retrieve Notice of Action (NOA) 01/23/1990
  Inventory as of this Action Requested Previously Approved
04/30/1993 04/30/1993 01/31/1990
216 0 216
8,910 0 8,910
0 0 0

PROS ARE AUTHORIZED TO REVIEW INPATIENT AND OUTPATIENT SERVICES FOR QUALITY OF CARE PROVIDED AND TO ELIMINATE UNREASONABLE, UNNECESSARY AND INAPPROPRIATE CARE PROVIDED TO MEDICARE BENEFICIARIES. THE PROS ARE REQUIRED TO REPORT THE RESULTS O THE REVIEW TO HCFA.

None
None


No

1
IC Title Form No. Form Name
MEDICARE - PRO REPORTING FORMS HCFA-613-619

  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 216 216 0 0 0 0
Annual Time Burden (Hours) 8,910 8,910 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.
01/23/1990


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