The Financial Statement of Debtor and Supporting Regulations in 42 CFR, Section 405.376

The Financial Statement of Debtor and Supporting Regulations in 42 CFR, Section 405.376

OMB: 0938-0270

IC ID: 7923

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The Financial Statement of Debtor and Supporting Regulations in 42 CFR, Section 405.376
 
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-379 No No


    

500 0
   
Private Sector Businesses or other for-profits
 
   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 500 0 0 0 0 500
Annual IC Time Burden (Hours) 1,000 0 0 0 0 1,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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