CRITERIA FOR MEDICARE COVERAGE OF ADULT LIVER TRANSPLANTS

ICR 199102-0938-002

OMB: 0938-0580

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
0938-0580 199102-0938-002
Historical Active
HHS/CMS
CRITERIA FOR MEDICARE COVERAGE OF ADULT LIVER TRANSPLANTS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/11/1991
Retrieve Notice of Action (NOA) 02/15/1991
  Inventory as of this Action Requested Previously Approved
04/30/1992 04/30/1992
73 0 0
7,500 0 0
0 0 0

MEDICARE PARTICIPATING HOSPITALS MUST FILE AN APPLICATION TO BE APPROVED FOR COVERAGE AND PAYMENT OF ADULT LIVER TRANSPLANTS PERFORMED ON MEDICARE BENEFICIARIES.

None
None


No

1
IC Title Form No. Form Name
CRITERIA FOR MEDICARE COVERAGE OF ADULT LIVER TRANSPLANTS HCFA-R-108

  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 73 0 0 73 0 0
Annual Time Burden (Hours) 7,500 0 0 7,500 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.
02/15/1991


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