Application for Reimbursement for Hospital Services in Canada

Application for Reimbursement for Hospital Services in Canada

OMB: 3220-0086

IC ID: 33891

Information Collection (IC) Details

View Information Collection (IC)

Application for Reimbursement for Hospital Services in Canada
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form AA-104 (01-02) Application for Canadian Hospital Benefits Under Medicare - Part A Form AA-104 (01-02).pdf No   Paper Only
Form AA-104 (proposed) Application for Canadian Hospital Benefits Under Medicare Part A AA-104(xx-xx)proposed.pdf No   Paper Only

Income Security General Retirement and Disability

RRB-20, Health Insurance and Medicare Medical Insurance Enrollment and Premium Payment System (Medicare) - RRB   72 FR 73513

35 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 35 0 0 -15 0 50
Annual IC Time Burden (Hours) 6 0 0 -2 0 8
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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