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Consolidated Renal Operations in a Web Enabled Network (CROWNWeb) Third-party Submission Authorization Form (2nd and 3rd Years)

IC 186858 under ICR 200810-0938-008 · OMB 0938-1052.

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Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Consolidated Renal Operations in a Web Enabled Network (CROWNWeb) Third-party Submission Authorization Form (2nd and 3rd Years)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10268 CMS-10268.CROWNWeb Batch Data Submission Authorization Form CROWNWeb Delegation of Authority Form _0 3_.pdf Yes No Fillable Fileable

Health Health Care Services

 

2,100 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 2,100 0 2,100 0 0 0
Annual IC Time Burden (Hours) 175 0 175 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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