Information Collection

Appeals Procedures For Determinations That Affect Participation In Medicare, Information Collection Requirements -- 42 Cfr 498

IC 113895 under ICR 199211-0938-006 · OMB 0938-0508.

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IC Title:

APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT PARTICIPATION IN MEDICARE, INFORMATION COLLECTION REQUIREMENTS -- 42 CFR 498

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-103				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

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Title	Document	Date Uploaded

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