This standardized form is used in the
Medicare/Medicaid program to apply for reimbursement of covered
services by all providers that accept Medicare/Medicaid assigned
claims and that do not bill Medicare and Medicaid
electronically.
This is not a program change.
This change corrects an error in the original submission. The total
requested burden in the Supporting Statement is correct, 1,786,799
hours. However, when the collection was first submitted, the total
requested burden was listed incorrectly on the 83-I form. The
number listed, 308,237 hours, is only part of the burden. The
actual burden should be 1,786,036 hours. The 1,477,799 hour
difference is attributed to the burden associated with EMC billing,
as stated in the supporting statement.
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Saleda Perryman
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.