Request for Medicare Payment, Ambulance -- 42 CFR Section 410.40 and 424.124

Request for Medicare Payment, Ambulance -- 42 CFR Section 410.40 and 424.124

OMB: 0938-0042

IC ID: 7796

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no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details

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Request for Medicare Payment, Ambulance -- 42 CFR Section 410.40 and 424.124
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-1491 Yes Yes


    

9,634,435 0
   
Private Sector Businesses or other for-profits
 
   82 %

  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 9,634,435 0 0 1,121,135 0 8,513,300
Annual IC Time Burden (Hours) 406,251 0 0 3,831 0 402,420
Annual IC Cost Burden (Dollars) 14,188,830,000 0 0 0 0 14,188,830,000

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