Proper Claim Not Filed and Supporting Regulation Contained in 42 CFR 411.32(c)

ICR 200310-0938-004

OMB: 0938-0564

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0564 200310-0938-004
Historical Active 199212-0938-004
HHS/CMS
Proper Claim Not Filed and Supporting Regulation Contained in 42 CFR 411.32(c)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 11/14/2003
Retrieve Notice of Action (NOA) 10/01/2003
  Inventory as of this Action Requested Previously Approved
11/30/2006 11/30/2006
13,311 0 0
1 0 0
0 0 0

42 CFR 411.32(c) is the section that requires a provider, supplier, or beneficiary to notify Medicare that a claim to a third party was improperly filed and that payment was reduced as a result.

None
None


No

1
IC Title Form No. Form Name
Proper Claim Not Filed and Supporting Regulation Contained in 42 CFR 411.32(c) CMS-R-136

  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 13,311 0 0 13,311 0 0
Annual Time Burden (Hours) 1 0 0 1 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
10/01/2003


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