Application for Hospital Insurance Benefits Medicare for Individuals with End Stage Renal Disease and Supporting Regulations in 42 CFR 406.7 and 406.13

Application for Hospital Insurance Benefits Medicare for Individuals with End Stage Renal Disease and Supporting Regulations in 42 CFR 406.7 and 406.13

OMB: 0938-0080

IC ID: 7835

Information Collection (IC) Details

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Application for Hospital Insurance Benefits Medicare for Individuals with End Stage Renal Disease and Supporting Regulations in 42 CFR 406.7 and 406.13
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 406.7 42 CFR 406.13

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-43 ApplicAtion for HospitAl InsurAnce Benefits for Individuals with End Stage Renal Disease CMS-43-508.pdf Yes Yes Paper Only

Health Health Care Services

 

60,000 0
   
Individuals or Households
 
   100 %

  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 60,000 0 0 0 0 60,000
Annual IC Time Burden (Hours) 25,990 0 0 0 0 25,990
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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