Request for Certification as Supplier of Portable X-Ray Services under the Medicare/Medicaid Program

Request for Certification as Supplier of Portable X-Ray Services under the Medicare/Medicaid Program

OMB: 0938-0027

IC ID: 7774

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Information Collection (IC) Details

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Request for Certification as Supplier of Portable X-Ray Services under the Medicare/Medicaid Program
 
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-1880 No No
Form HCFA-1882 No No


    

520 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 78 0 78 0 0 0
Annual IC Time Burden (Hours) 137 0 137 0 0 0
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.

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