Information Collection

Medicare Secondary Payer Information Collection

IC 7889 under ICR 201310-0938-008 · OMB 0938-0214.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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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:

table that charts list of 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: 143,070,217

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	143,070,217	143,070,217
Annual IC Time Burden (Hours)	1,788,057	1,788,057
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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