ESTABLISHING PROCEDURES FOR TRANSMITTING INFORMATION BETWEEN MEDICARE CARRIERS AND MEDICARE SUPPLEMENTAL INSURERS

ICR 199008-0938-007

OMB: 0938-0571

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0571 199008-0938-007
Historical Active
HHS/CMS
ESTABLISHING PROCEDURES FOR TRANSMITTING INFORMATION BETWEEN MEDICARE CARRIERS AND MEDICARE SUPPLEMENTAL INSURERS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 11/09/1990
Retrieve Notice of Action (NOA) 08/17/1990
  Inventory as of this Action Requested Previously Approved
08/31/1993 08/31/1993
86,400,000 0 0
4,493,050 0 0
0 0 0

TO ACCOMPLISH TRANSFER OF CLAIM INFORMATION MANDATED BY SECTION 4081 OF OBRA 1987, PARTICIPATING PHYSICIANS'/SUPPLIERS' STAFFS, STATES AND MEDIGAP INSURERS THEMSELVES MUST FURNISH INFORMATION TO IDENTIFY SUCH INSURERS. SPECIFIED CONTENT OF MEDIGAP INSURANCE CARDS IS ALSO NECESSARY FOR CORRECT ROUTING OF CLAIMS. NOTIFICATION OF BENEFICIARIE VERIFIES APPROPRIATE PAYMENT.

None
None


No

1
IC Title Form No. Form Name
ESTABLISHING PROCEDURES FOR TRANSMITTING INFORMATION BETWEEN MEDICARE CARRIERS AND MEDICARE SUPPLEMENTAL INSURERS HCFA-R-140

  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 86,400,000 0 0 86,400,000 0 0
Annual Time Burden (Hours) 4,493,050 0 0 4,493,050 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.
08/17/1990


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