Medicare Secondary Payer Informaiton Collection and Supp. Regs. in 42 CFR 489.20, 411.25, 489.2

ICR 200603-0938-011

OMB: 0938-0214

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0214 200603-0938-011
Historical Active 200506-0938-006
HHS/CMS
Medicare Secondary Payer Informaiton Collection and Supp. Regs. in 42 CFR 489.20, 411.25, 489.2
Extension without change of a currently approved collection   No
Regular
Approved without change 05/03/2006
Retrieve Notice of Action (NOA) 03/31/2006
  Inventory as of this Action Requested Previously Approved
05/31/2009 05/31/2009 05/31/2006
124,553,682 0 134,553,682
1,611,303 0 1,605,415
0 0 0

Medicare Secondary Payer (MSP) is essentially the same concept known in the private insurance industry as coordination of benefits and refers to those situations where Medicare does not have primary responsibility for paying the medical expenses of a Medicare beneficiary. Medicare Fiscal Intermediaries. Carriers, and now Part D plans, need information about primary payers in order to perform various tasks to detect and process MSP cases, and make recoveries.

None
None


No

1
IC Title Form No. Form Name
Medicare Secondary Payer Informaiton Collection and Supp. Regs. in 42 CFR 489.20, 411.25, 489.2 250-254

  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 124,553,682 134,553,682 0 0 -10,000,000 0
Annual Time Burden (Hours) 1,611,303 1,605,415 0 0 5,888 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.
03/31/2006


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