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Appointment of Representative and Supporting Regulations in 42 CFR 405.910 (Beneficiary)

IC 8804 under ICR 200807-0938-001 · OMB 0938-0950.

Documents and Forms
Document Name
Document Type
Other-Redline
Form and Instruction
IC Document
Information Collection (IC) Details

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Appointment of Representative and Supporting Regulations in 42 CFR 405.910 (Beneficiary)
 
No Modified
 
Voluntary
 
42 CFR 405.910

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Redline AOR FORM 1696 revisions_redline_031808.doc Yes Yes Paper Only
Form and Instruction CMS-1696 Appointment of Representative AOR FORM 1696 revisions_clean_031808.doc Yes Yes Paper Only

Health Health Care Services

 

26,827 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 26,827 0 0 -5,428,634 0 5,455,461
Annual IC Time Burden (Hours) 6,707 0 0 -112 0 6,819
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CROSSWALK DOCUMENT CMS1696_031808 CROSSWALK DOCUMENT CMS1696_031808.doc 06/16/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.