Review of National Coverage Determinations and Local Coverage Determinations and Supporting Regulations in 42 CFR, Sections 426.400 and 426.500

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IC Title:	Review of National Coverage Determinations and Local Coverage Determinations and Supporting Regulations in 42 CFR, Sections 426.400 and 426.500	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10099				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,040	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,040	1,040
Annual IC Time Burden (Hours)	4,160	4,160
Annual IC Cost Burden (Dollars)	0	0

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