Emergency and Foreign Hospital Services -- Beneficiary Statement in Canadian Travel Claims and Supporting Regulations in 42 CFR, Section 424.123

Emergency and Foreign Hospital Services -- Beneficiary Statement in Canadian Travel Claims and Supporting Regulations in 42 CFR, Section 424.123

OMB: 0938-0484

IC ID: 8107

Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details

View Information Collection (IC)

Emergency and Foreign Hospital Services -- Beneficiary Statement in Canadian Travel Claims and Supporting Regulations in 42 CFR, Section 424.123
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-R-96 No No


    

1,100 0
   
Individuals or Households
 
   0 %

  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 1,100 0 0 0 0 1,100
Annual IC Time Burden (Hours) 275 0 0 0 0 275
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

© 2024 OMB.report | Privacy Policy