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Health Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424, Subpart C

IC 7761 under ICR 200603-0938-005 · OMB 0938-0008.

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Health Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424, Subpart C
 
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-1490S Yes Yes
Form CMS-1500(12-90) Yes Yes
Form CMS-1490U Yes Yes


    

902,378 0
   
State, Local, and Tribal Governments
 
   86 %

  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 957,204,707 0 0 216,989,572 0 740,215,135
Annual IC Time Burden (Hours) 46,383,364 0 0 2,194,357 0 44,189,007
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
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