Information Collection

Information Collection Requirements Contained in BPD-718: Advance Directive (Medicare and Medicaid)

IC 8207 under ICR 199605-0938-009 · OMB 0938-0610.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0610 can be found here:

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Information Collection (IC) Details

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IC Title:	Information Collection Requirements Contained in BPD-718: Advance Directive (Medicare and Medicaid)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R10				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 38,927	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	38,927	6,127	32,800
Annual IC Time Burden (Hours)	908,250	158,250	750,000
Annual IC Cost Burden (Dollars)	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.