Information Collection

Payment Invoices (42 CFR 152.32)

IC 193919 under ICR 201012-0938-019 · OMB 0938-1100.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1100 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Payment Invoices (42 CFR 152.32)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 152.32

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	612	612
Annual IC Time Burden (Hours)	9,792	9,792
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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