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Third Party Premium Billing Request and Supporting Regulations in 42 CFR 408.6 and 408.202

IC 7794 under ICR 200310-0938-001 · OMB 0938-0041.

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Third Party Premium Billing Request and Supporting Regulations in 42 CFR 408.6 and 408.202
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-2384 No No


    

17,350 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 17,350 0 2,350 0 0 15,000
Annual IC Time Burden (Hours) 6,446 0 196 0 0 6,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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