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Federal forms, ICRs, and supporting documents

Information Collection

Bounceback Form for Medicare and You on WWW.Medicare.Gov

IC 8424 under ICR 199901-0938-003 · OMB 0938-0740.

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Information Collection (IC) Details

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Bounceback Form for Medicare and You on WWW.Medicare.Gov
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-R-251 Yes Yes


    

9,855 0
   
Individuals or Households
 
   100 %

  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 9,855 0 0 0 0 9,855
Annual IC Time Burden (Hours) 986 0 0 0 0 986
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.