CRITERIA FOR MEDICARE COVERAGE OF ADULT HEART TRANSPLANTS

ICR 199410-0938-004

OMB: 0938-0490

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0490 199410-0938-004
Historical Active 199302-0938-009
HHS/CMS
CRITERIA FOR MEDICARE COVERAGE OF ADULT HEART TRANSPLANTS
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 12/20/1994
Retrieve Notice of Action (NOA) 10/07/1994
Approved for use through 04/95 under the condition that the next submission for OMB review includes a revised burden estimate incorporating the burden imposed by centers voluntarily submitting "updated data for selected elements" (Item 7 of the Supporting Statement). In its Supporting Statement, HCFA should explain which "selected elements" are being collected to "re-evaluate the criteria for approval as a Medicare heart transplant center."
  Inventory as of this Action Requested Previously Approved
04/30/1995 04/30/1995
8 0 0
2,260 0 0
0 0 0

MEDICARE PARTICIPATING HOSPITALS MUST FILE AN APPLICATION TO BE APPROV FOR COVERAGE AND PAYMENT OF ADULT HEART TRANSPLANTS PERFORMED ON MEDICARE BENEFICIARIES.

None
None


No

1
IC Title Form No. Form Name
CRITERIA FOR MEDICARE COVERAGE OF ADULT HEART TRANSPLANTS HCFA-R-106

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 8 0 0 8 0 0
Annual Time Burden (Hours) 2,260 0 0 2,260 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/07/1994


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