Medicare Secondary Payer Information Collection and Supporting Regulations in 42 CFR 411.25, 489.2, and 489.20

ICR 200107-0938-018

OMB: 0938-0214

Federal Form Document

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Document
Name
Status
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ICR Details
0938-0214 200107-0938-018
Historical Active 200011-0938-001
HHS/CMS
Medicare Secondary Payer Information Collection and Supporting Regulations in 42 CFR 411.25, 489.2, and 489.20
Extension without change of a currently approved collection   No
Emergency 07/16/2001
Approved without change 09/10/2001
Retrieve Notice of Action (NOA) 07/06/2001
Approved for use through 3/2002 under the conditions that CMS: 1) consistent with its commitment expressed in the enclosed M-TAG minutes, continues to consider its legislative, regulatory and program cnostraints and flexibilities in managing hospital reference lab collections and conscientiously responds to public comments on this issue; and 2) submits under separate cover in a correction worksheet, a detailed explanation of the difference in its burden estimate of MSP collections and the burden reduction due to the new policies contained in this submission.
  Inventory as of this Action Requested Previously Approved
05/31/2002 05/31/2002 01/31/2002
867,863,540 0 14,204,000
773,240 0 773,240
0 0 0

Medicare Secondary Payer (MSP) is essentially the same concept known in the private insurance industry as coordination of benefits and refers to those situations where Medicare does not have primary responsibility for paying the medical expenses of a Medicare beneficiary. Medicare intermediaries and carriers must collect information to perform various tasks to detect and process MSP cases.

None
None


No

1
IC Title Form No. Form Name
Medicare Secondary Payer Information Collection and Supporting Regulations in 42 CFR 411.25, 489.2, and 489.20 HCFA-250-254

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 867,863,540 14,204,000 0 853,659,540 0 0
Annual Time Burden (Hours) 773,240 773,240 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/06/2001


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