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Federal forms, ICRs, and supporting documents

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Emergency and Foreign Hospital Services - Beneficiary Statement in Canadian/Mexican Travel Claims and Supporting Regulations in 42 CFR, Section 424.123

IC 8108 under ICR 200609-0938-002 · OMB 0938-0484.

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Information Collection (IC) Details

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Information Collection Instruments:
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Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Federal Enterprise Architecture Business Reference Module


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  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 1,100 0 0 0 0 1,100
Annual IC Time Burden (Hours) 275 0 0 0 0 275
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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