Information Collection

Attending Physician's Certification of Medical Necessity for Home Oxygen Therapy and Supporting Regulatoins 42 CFR 410.38 and 42 CFR 424.5

IC 8144 under ICR 200303-0938-013 · OMB 0938-0534.

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Information Collection (IC) Details

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IC Title:	Attending Physician's Certification of Medical Necessity for Home Oxygen Therapy and Supporting Regulatoins 42 CFR 410.38 and 42 CFR 424.5	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-484				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 175,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	700,000	200,000	500,000
Annual IC Time Burden (Hours)	116,000	66,000	50,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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