Request for Termination of Premium Hospital and/or Supplementary Medical Insurance and Supporting Regulations on 42 CFR 406.28 and 407.27

Request for Termination of Premium Hospital and/or Supplementary Medical Insurance and Supporting Regulations on 42 CFR 406.28 and 407.27

OMB: 0938-0025

IC ID: 7771

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Request for Termination of Premium Hospital and/or Supplementary Medical Insurance and Supporting Regulations on 42 CFR 406.28 and 407.27
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-1763 No No


    

14,000 0
   
Individuals or Households
 
   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 14,000 0 14,000 0 0 0
Annual IC Time Burden (Hours) 5,833 0 5,833 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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