Information Collection

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

IC 184092 under ICR 200803-0938-003 · OMB 0938-1049.

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Information Collection (IC) Details

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IC Title:	Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 424.36(b)

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,500,000	6,500,000
Annual IC Time Burden (Hours)	541,667	541,667
Annual IC Cost Burden (Dollars)	0	0

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