Medicare Contractor Administrative Budget And Cost Reporting System Forms

MEDICARE CONTRACTOR ADMINISTRATIVE BUDGET AND COST REPORTING SYSTEM FORMS

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0350 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	MEDICARE CONTRACTOR ADMINISTRATIVE BUDGET AND COST REPORTING SYSTEM FORMS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-1523	No	No
Form	1523A, 1523B	No	No
Form	1523C, 1523D	No	No
Form	1523E, 1524	No	No
Form	1524A, 1524B	No	No
Form	1524C, 1524D	No	No
Form	1524E, 2580	No	No
Form	3258, 3259	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 86	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,462	0	1,462
Annual IC Time Burden (Hours)	80,016	9,632	70,384
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.