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Medicare Secondary Payer Information Collection
Medicare Secondary Payer Informaiton Collection and Supp. Regs. in 42 CFR 489.20, 411.25, 489.2
OMB: 0938-0214
IC ID: 7889
OMB.report
HHS/CMS
OMB 0938-0214
ICR 201310-0938-008
IC 7889
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medicare Secondary Payer Information Collection
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR 489.20
42 CFR 411.25
42 CFR 489.2
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
143,070,217
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
25 %
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
143,070,217
0
0
0
143,070,217
0
Annual IC Time Burden (Hours)
1,788,057
0
0
0
1,788,057
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.