Information Collection

Medicare Part B Buy-In Screening Guides

IC 9584 under ICR 199908-0960-012 · OMB 0960-0601.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0601 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Medicare Part B Buy-In Screening Guides	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 44,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 55 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	44,500	20,502	-106,002	130,000
Annual IC Time Burden (Hours)	14,834	6,834	-35,334	43,334
Annual IC Cost Burden (Dollars)	0	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.