Information Collection

Request for Medicare Payment -- Ambulance and Supporting Regulations in 42 CFR Sections 410.1, 410.40, 424.124, 424.601, 414.605, 414.610, 414.615, 414.620, 414.625, and 424.32

IC 7798 under ICR 200402-0938-005 · OMB 0938-0042.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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Information Collection (IC) Details

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IC Title:

Request for Medicare Payment -- Ambulance and Supporting Regulations in 42 CFR Sections 410.1, 410.40, 424.124, 424.601, 414.605, 414.610, 414.615, 414.620, 414.625, and 424.32

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-1491				No	No

Federal Enterprise Architecture Business Reference Module

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,334

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	240,000	-9,061,183	9,301,183
Annual IC Time Burden (Hours)	60,010	-330,408	390,418
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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

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