Advance Beneficiary Notice and Supporting Regulations in 42 CFR 411.404, 411.406, and 411.408

ICR 200404-0938-001

OMB: 0938-0566

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0566 200404-0938-001
Historical Active 200306-0938-001
HHS/CMS
Advance Beneficiary Notice and Supporting Regulations in 42 CFR 411.404, 411.406, and 411.408
Extension without change of a currently approved collection   No
Regular
Approved without change 05/28/2004
Retrieve Notice of Action (NOA) 04/08/2004
  Inventory as of this Action Requested Previously Approved
05/31/2007 05/31/2007 05/31/2004
21,171,480 0 20,235,430
1,764,290 0 1,686,286
0 0 0

Physicians, practitioners, suppliers, and providers furnishing Part A or Part B items or services may bill a patient for items or services denied by Medicare as not reasonable and necessary, under Medicare program standards (sec. 1862(a)(1)) of title XVIII of the Social Security Act (the Act), or under one of several other statutory based (sec. 1862(a)(9)), 1814(a)(2)(C), 1835(a)(2)(A), 1861(dd)(3)(A), 1834(j)(1), 1834(a)(15), and 1834(a)(17)(B) of the Act), if they informed the patient, prior to furnishing the items or services, that Medicare was likely to deny payment for the items or services....

None
None


No

1
IC Title Form No. Form Name
Advance Beneficiary Notice and Supporting Regulations in 42 CFR 411.404, 411.406, and 411.408 CMS-R-131

  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 21,171,480 20,235,430 0 0 936,050 0
Annual Time Burden (Hours) 1,764,290 1,686,286 0 0 78,004 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
04/08/2004


© 2024 OMB.report | Privacy Policy