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Information Collection

Information Collection Requirements At 42 Cfr 411.54(c)(1) Itemized Statement Of Hospital Charges

IC 113977 under ICR 199111-0938-002 · OMB 0938-0558.

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Information Collection (IC) Details

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INFORMATION COLLECTION REQUIREMENTS AT 42 CFR 411.54(C)(1) ITEMIZED STATEMENT OF HOSPITAL CHARGES
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-R-134 No No


    

1 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 1 0 0 0 0 1
Annual IC Time Burden (Hours) 1 0 0 0 0 1
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.