Request For Field Test Of Medical Review Of Part B Intermediary Outpatient Therapy Claims

REQUEST FOR FIELD TEST OF MEDICAL REVIEW OF PART B INTERMEDIARY OUTPATIENT THERAPY CLAIMS

OMB: 0938-0227

IC ID: 113179

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REQUEST FOR FIELD TEST OF MEDICAL REVIEW OF PART B INTERMEDIARY OUTPATIENT THERAPY CLAIMS
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-700 No No
Form 701 No No


    

5,020,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Requested 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 5,020,000 0 0 0 0 5,020,000
Annual IC Time Burden (Hours) 2,510,000 0 0 0 0 2,510,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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