Certificate of Medical Necessity

Certificate of Medical Necessity

OMB: 1240-0024

IC ID: 13782

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Information Collection (IC) Details

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Certificate of Medical Necessity
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.701 20 CFR 725.706 20 CFR 725.707

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CM-893 Certificate of Medical Necessity CM-893 Rev May 2008 DRAFT.pdf Yes No Fillable Printable

Health Health Care Services

ESA-6 and ESA-30  67 FR 16869

3,200 480
   
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 3,200 0 0 -800 0 4,000
Annual IC Time Burden (Hours) 1,253 0 0 -314 0 1,567
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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