Information Collection

Procedures For Determining Whether Providers, Practitioners, Or Other Suppliers Of Services Are Liable For_certain Uncovered Services, Medicare -- Berc-273f

IC 113796 under ICR 199307-0938-002 · OMB 0938-0465.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0465 can be found here:

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Information Collection (IC) Details

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IC Title:	PROCEDURES FOR DETERMINING WHETHER PROVIDERS, PRACTITIONERS, OR OTHER SUPPLIERS OF SERVICES ARE LIABLE FOR_CERTAIN UNCOVERED SERVICES, MEDICARE -- BERC-273F	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-R-77				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,965	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	87,615	-73,510	161,125
Annual IC Time Burden (Hours)	7,301	-5,946	13,247
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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