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

Appointment of Representative and Supporting Regulations in 42 CFR 405.910

OMB: 0938-0950

IC ID: 185564

Information Collection (IC) Details

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-1696 (English) Appointment of Representative AOR FORM 1696 revisions_Final.docx Yes No Paper Only
Form and Instruction CMS-1696 (Spanish) NOMBRAMIENTO DE REPRESENTANTE CMS1696-S.docx Yes No Paper Only

Health Health Care Services

 

241,441 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 241,441 0 0 0 0 241,441
Annual IC Time Burden (Hours) 60,360 0 0 0 0 60,360
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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