Health Insurance Common Claims Formand Supporting Regulations: 42 CFR 414.40, 424.32, 424.44

Health Insurance Common Claims Formand Supporting Regulations: 42 CFR 414.40, 424.32, 424.44

OMB: 0938-0008

IC ID: 7760

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Health Insurance Common Claims Formand Supporting Regulations: 42 CFR 414.40, 424.32, 424.44
 
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 CMS-1490U Yes Yes
Form CMS-1500 Yes Yes
Form CMS-1490S Yes Yes


    

1,216,702 0
   
State, Local, and Tribal Governments
 
   82 %

  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 740,215,135 0 0 0 0 740,215,135
Annual IC Time Burden (Hours) 44,189,007 0 0 0 0 44,189,007
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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