Hospital Request for Certification in the Medicare/Medicaid Program

Hospital Request for Certification in the Medicare/Medicaid Program

OMB: 0938-0380

IC ID: 8024

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

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Hospital Request for Certification in the Medicare/Medicaid Program
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-1514 No No


    

6,300 0
   
State, Local, and Tribal Governments
 
   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 2,000 0 0 -500 0 2,500
Annual IC Time Burden (Hours) 500 0 0 -125 0 625
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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