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Medicare Therapeutic Shoe Demonstration Program Certification And Prescription Form

IC 166328 under ICR 199106-0938-008 · OMB 0938-0533.

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MEDICARE THERAPEUTIC SHOE DEMONSTRATION PROGRAM CERTIFICATION AND PRESCRIPTION FORM
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-609 No No


    

27,488 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 27,488 0 0 0 0 27,488
Annual IC Time Burden (Hours) 2,291 0 0 0 0 2,291
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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