OMB
.report
Search
Proper Claim Not Filed and Supporting Regulation Contained in 42 CFR 411.32(c)
Proper Claim Not Filed and Supporting Regulation Contained in 42 CFR 411.32(c)
OMB: 0938-0564
IC ID: 8150
OMB.report
HHS/CMS
OMB 0938-0564
ICR 200310-0938-004
IC 8150
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0564 can be found here:
2006-10-17 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Proper Claim Not Filed and Supporting Regulation Contained in 42 CFR 411.32(c)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-R-136
Yes
Yes
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
13,311
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
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
13,311
0
13,311
0
0
0
Annual IC Time Burden (Hours)
1
0
1
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.