Federal Funding of Emergency Health Services;Request for Section 1011 Hospital On-call Payments to Physicians (CMS-10130B)

Federal Funding of Emergency Health Services (Section 1011); Provider Payment Determination and On-Call Cost Forms

OMB: 0938-0952

IC ID: 187085

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Federal Funding of Emergency Health Services;Request for Section 1011 Hospital On-call Payments to Physicians (CMS-10130B)
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10130B REQUEST FOR SECTION 1011 HOSPITAL ON-CALL PAYMENTS TO PHYSICIANS CMS10130B.PDF Yes Yes Paper Only

Health Health Care Services

 

37 0
   
Private Sector Businesses or other for-profits
 
   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 148 0 0 148 0 0
Annual IC Time Burden (Hours) 37 0 0 37 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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