MEDICARE, INFORMATION COLLECTION REQUIREMENTS IN 405.2112, 405.2123, 405.2136, 405.2137, 405.2138, 405.2139, 405.2140, AND 405.2171

ICR 199410-0938-008

OMB: 0938-0386

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0386 199410-0938-008
Historical Active 199109-0938-002
HHS/CMS
MEDICARE, INFORMATION COLLECTION REQUIREMENTS IN 405.2112, 405.2123, 405.2136, 405.2137, 405.2138, 405.2139, 405.2140, AND 405.2171
Revision of a currently approved collection   No
Regular
Approved without change 12/20/1994
Retrieve Notice of Action (NOA) 10/12/1994
  Inventory as of this Action Requested Previously Approved
03/31/1998 03/31/1998 11/30/1994
2,321 0 2,000
87,094 0 9,000
0 0 0

NEEDED TO ENCOURAGE PROPER DISTRIBUTION AND EFFECTIVE UTILIZATION OF ESRD TREATMENT SOURCES WHILE MAINTAINING AND IMPROVING THE EFFICIENT DELIVERY OF CARE BY PHYSICIANS AND FACILITIES.

None
None


No

1
IC Title Form No. Form Name
MEDICARE, INFORMATION COLLECTION REQUIREMENTS IN 405.2112, 405.2123, 405.2136, 405.2137, 405.2138, 405.2139, 405.2140, AND 405.2171 HCFA-R-52

  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 2,321 2,000 0 321 0 0
Annual Time Burden (Hours) 87,094 9,000 0 78,094 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.
10/12/1994


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