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Information Collection

Medicare Intermediary Request to Skilled Nursing Facilities for Medical Information on Claims to be Processed

IC 113163 under ICR 199504-0938-002 · OMB 0938-0223.

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Information Collection (IC) Details

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Medicare Intermediary Request to Skilled Nursing Facilities for Medical Information on Claims to be Processed
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-9031 No No


    

12,536 0
   
Private Sector Businesses or other for-profits
 
   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 111,925 0 111,925 0 0 0
Annual IC Time Burden (Hours) 55,963 0 55,963 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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