Information Collection

Medicare Contractor Administrative Budget And Cost Reporting System Forms

IC 113496 under ICR 199212-0938-005 · OMB 0938-0350.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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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:

table that charts list of 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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,462	1,462
Annual IC Time Burden (Hours)	80,016	80,016
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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