Submission of Significant Hardship Exemption to Avoid the eRx Payment Adjustment

eRx Incentive Program Submission of Significant Hardship Exemption to Avoid the eRx Payment Adjustment

OMB: 0938-1138

IC ID: 197992

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Submission of Significant Hardship Exemption to Avoid the eRx Payment Adjustment
 
No New
 
Voluntary
 
42 CFR 414.92

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

Health Health Care Services

 

110,106 110,106
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 110,106 110,106 0 0 0 0
Annual IC Time Burden (Hours) 220,212 220,212 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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