Medicare - Plan Of Treatment & Home Health Certification Form, Medical Information, Form, Addendum To The Pot & Mif, And Intermediary Medical Information Request

MEDICARE - PLAN OF TREATMENT & HOME HEALTH CERTIFICATION FORM, MEDICAL INFORMATION, FORM, ADDENDUM TO THE POT & MIF, AND INTERMEDIARY MEDICAL INFORMATION REQUEST

OMB: 0938-0357

IC ID: 113521

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MEDICARE - PLAN OF TREATMENT & HOME HEALTH CERTIFICATION FORM, MEDICAL INFORMATION, FORM, ADDENDUM TO THE POT & MIF, AND INTERMEDIARY MEDICAL INFORMATION REQUEST
 
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 486, 487, No No
Form 488 No No
Form HCFA-485, No No


    

5,700 0
   
Private Sector Businesses or other for-profits
 
   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 6,825,000 0 0 3,606,073 0 3,218,927
Annual IC Time Burden (Hours) 1,706,250 0 0 230,908 0 1,475,342
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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