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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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Emergency and Foreign Hospital Services - Beneficiary Statement in Canadian/Mexican Travel Claims and Supporting Regulations in 42 CFR, Section 424.123
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 424.123

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

Health Health Care Services

 

1,100 0
   
Individuals or Households
 
   0 %

  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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