Medicare EDI Enrollment Form and EDI Registration

ICR 201302-0938-010

OMB: 0938-0983

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2013-02-24
Supporting Statement A
2013-02-24
IC Document Collections
ICR Details
0938-0983 201302-0938-010
Historical Active 200903-0938-008
HHS/CMS 18916
Medicare EDI Enrollment Form and EDI Registration
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 06/10/2013
Retrieve Notice of Action (NOA) 02/27/2013
  Inventory as of this Action Requested Previously Approved
06/30/2016 36 Months From Approved
240,000 0 0
80,000 0 0
0 0 0

Federal law requires that CMS minimize the security risk to federal information systems. CMS is requiring that trading partners who wish to conduct the Electronic Data Interchange (EDI) transactions provide certain assurance as a condition of receiving access to the Medicare system for the purpose of conducting EDI exchanges. Health care providers, clearinghouses, and health plans that wish access to the Medicare system are required to complete this form. The information will be used to assure that those entities that access the Medicare system are aware of applicable provisions and penalties.

PL: Pub.L. 104 - 191 261 Name of Law: Purpose
   PL: Pub.L. 104 - 191 262 Name of Law: Administrative Simplification
  
None

Not associated with rulemaking

  77 FR 57090 09/17/2012
78 FR 12322 02/22/2013
No

1
IC Title Form No. Form Name
Medicare EDI Enrollment Form and EDI Registration CMS-10164, CMS-10164 Accesible EDI Registration Form ,   Accessible EDI Enrollment Form

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 240,000 0 0 0 0 240,000
Annual Time Burden (Hours) 80,000 0 0 0 0 80,000
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
No
No
No
Uncollected
Kayla Williams 410 786-5887 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/27/2013


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