Information Collection

Phone Surveys of Product/Service for Medicare Payment Validation and Supporting Regulations in 42 CFR, 405.502 (CMS-10112)

IC 8790 under ICR 200805-0938-002 · OMB 0938-0939.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0939 can be found here:

Documents and Forms

Document Name Document Type
10112-instructions.doc Other-IR Manual
10112-manual.doc Other-CMS-Manual System

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Phone Surveys of Product/Service for Medicare Payment Validation and Supporting Regulations in 42 CFR, 405.502 (CMS-10112)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 405.502

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-IR Manual			10112-instructions.doc		Yes	Yes	Paper Only
Other-CMS-Manual System			10112-manual.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	Number of Respondents for Small Entity: 750

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,000	2,000	2,000
Annual IC Time Burden (Hours)	16,000	0	16,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.