OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity and Supporting Documentation Requirements

IC 8700 under ICR 200602-0938-005 · OMB 0938-0875.

Documents and Forms
Document Name
Document Type
No indexed documents/forms are available for this IC yet. A refresh has been queued.
Information Collection (IC) Details

View Information Collection (IC)

Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity and Supporting Documentation Requirements
 
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-843 Yes Yes


    

17,000 0
   
Private Sector Businesses or other for-profits
 
   90 %

  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 187,000 0 187,000 0 0 0
Annual IC Time Burden (Hours) 31,167 0 31,167 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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