Information Collection Requirements Contained in BDP-718; Advanced Directives (Medicare and Medicaid) and Supporting in 42 CFR Sections 417.436, 417.801, 422.128, 430.12, 431.20....

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Information Collection (IC) Details

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IC Title:	Information Collection Requirements Contained in BDP-718; Advanced Directives (Medicare and Medicaid) and Supporting in 42 CFR Sections 417.436, 417.801, 422.128, 430.12, 431.20....	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-R-10				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35,905	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35,905	-3,022	38,927
Annual IC Time Burden (Hours)	908,250	0	908,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.