Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)

ICR 200803-0938-003

OMB: 0938-1049

Federal Form Document

Forms and Documents
ICR Details
0938-1049 200803-0938-003
Historical Active
HHS/CMS
Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/04/2008
Retrieve Notice of Action (NOA) 03/11/2008
  Inventory as of this Action Requested Previously Approved
08/31/2011 36 Months From Approved
6,500,000 0 0
541,667 0 0
0 0 0

Because it is very difficult to obtain a beneficiary's signature (or the signature of a person authorized to sign on behalf of the beneficiary) on a claim when the beneficiary is being transported by ambulance in emergency situations, we are proposing that, for emergency ambulance transport services, an ambulance provider or supplier may submit the claim without a beneficiary's signature, as long as certain documentation requirements are met.

Statute at Large: 18 Stat. 1835 Name of Statute: null
   Statute at Large: 18 Stat. 1814 Name of Statute: null
   Statute at Large: 18 Stat. 1842 Name of Statute: null
   Statute at Large: 18 Stat. 1848 Name of Statute: null
  
None

0938-AO65 Final or interim final rulemaking 72 FR 66580 11/27/2007

  72 FR 38601 07/13/2007
73 FR 8877 02/15/2008
No

1
IC Title Form No. Form Name
Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)

  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 6,500,000 0 0 6,500,000 0 0
Annual Time Burden (Hours) 541,667 0 0 541,667 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
CMM is adding 424.36(b)(6), so that, in certain emergency ambulance transport situations, an ambulance provider or supplier may submit a claim to Medicare without the beneficiary's signature if certain documentation requirements are met.

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Bonnie Harkless 4107865666

  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.
03/11/2008


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