Medicare EDI Enrollment Form and EDI Registration

Medicare EDI Enrollment Form and EDI Registration

OMB: 0938-0983

IC ID: 8845

Information Collection (IC) Details

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Medicare EDI Enrollment Form and EDI Registration
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 162

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10164 Accesible EDI Registration Form CMS-10164_Medicare_EDI_Registration_(7-31-12)_v2.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10164 Accessible EDI Enrollment Form CMS-10164_EDI_ENROLL(8-8-12).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

240,000 0
   
Private Sector Businesses or other for-profits
 
   100 %

  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 240,000 0 0 0 240,000 0
Annual IC Time Burden (Hours) 80,000 0 0 0 80,000 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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