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: 8108

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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 CMS-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

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