Information Collection

Questions On Other Insurance Available To Medicare Beneficiaries, Medicare Secondary Payer

IC 113139 under ICR 199304-0938-007 · OMB 0938-0214.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0214 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	QUESTIONS ON OTHER INSURANCE AVAILABLE TO MEDICARE BENEFICIARIES, MEDICARE SECONDARY PAYER	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-250	No	No
Form	THROUGH	No	No
Form	FREQ	No	No
Form	254	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,600,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,600,000	2,600,000
Annual IC Time Burden (Hours)	650,000	650,000
Annual IC Cost Burden (Dollars)	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.