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Medicare Qualification Statement for Federal Employees and Supporting Regulations in 42 CFR 406.15

IC 8119 under ICR 200402-0938-008 · OMB 0938-0501.

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Medicare Qualification Statement for Federal Employees and Supporting Regulations in 42 CFR 406.15
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-565 No No


    

4,300 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 4,300 0 0 0 0 4,300
Annual IC Time Burden (Hours) 717 0 0 -14 0 731
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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