RECORDKEEPING REQUIREMENTS CONTAINED IN PROVIDER REIMBURSEMENT MANUAL SECTIONS 2198 AND 2746

ICR 199005-0938-006

OMB: 0938-0499

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0499 199005-0938-006
Historical Active 198702-0938-007
HHS/CMS
RECORDKEEPING REQUIREMENTS CONTAINED IN PROVIDER REIMBURSEMENT MANUAL SECTIONS 2198 AND 2746
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 08/29/1990
Retrieve Notice of Action (NOA) 05/31/1990
  Inventory as of this Action Requested Previously Approved
08/31/1993 08/31/1993
9,000 0 0
2,250 0 0
0 0 0

THIS REQUIRES TRANSPLANTATION FACILITIES TO DOCUMENT THEIR EFFORTS IN PLACING A HARVESTED KIDNEY IN MEDICARE-ELIGIBLE PATIENT.

None
None


No

1
IC Title Form No. Form Name
RECORDKEEPING REQUIREMENTS CONTAINED IN PROVIDER REIMBURSEMENT MANUAL SECTIONS 2198 AND 2746 HCFA-R=105

  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 9,000 0 0 9,000 0 0
Annual Time Burden (Hours) 2,250 0 0 2,250 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
05/31/1990


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