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Installment Agreement on Beneficiary Refund of Overpayment, HCFA-Pub. 13-3 and HCFA-Pub. 14-3

IC 113126 under ICR 199507-0938-002 · OMB 0938-0211.

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Installment Agreement on Beneficiary Refund of Overpayment, HCFA-Pub. 13-3 and HCFA-Pub. 14-3
 
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-9005 Yes Yes


    

6,000 0
   
Individuals or Households
 
   16 %

  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 6,000 0 0 6,000 0 0
Annual IC Time Burden (Hours) 960 0 0 322 0 638
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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