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Medicare Contractor Administrative Budget And Cost Reporting System Forms
MEDICARE CONTRACTOR ADMINISTRATIVE BUDGET AND COST REPORTING SYSTEM FORMS
OMB: 0938-0350
IC ID: 113496
OMB.report
HHS/CMS
OMB 0938-0350
ICR 199212-0938-005
IC 113496
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
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.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
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
Federal Enterprise Architecture Business Reference Module
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 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
1,462
0
0
0
0
1,462
Annual IC Time Burden (Hours)
80,016
0
0
0
0
80,016
Annual IC Cost Burden (Dollars)
0
0
0
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.