Information Collection

Request for Accelerated Payments and Supporting Regulations in 42 CFR Section 412.116 and 413.64

IC 7919 under ICR 199909-0938-008 · OMB 0938-0269.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0269 can be found here:

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Information Collection (IC) Details

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IC Title:	Request for Accelerated Payments and Supporting Regulations in 42 CFR Section 412.116 and 413.64	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
Form	HCFA-9042				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 890	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	890	36	854
Annual IC Time Burden (Hours)	445	18	427
Annual IC Cost Burden (Dollars)	0	0	0

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Title	Document	Date Uploaded

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