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#32: Provider-Preventable Conditions under 42 CFR 438.6 and 447.26 and Title 2702 Non-Payment Preprint (Attachment 4.19) (CMS-10364)

IC 214365 under ICR 201410-0938-016 · OMB 0938-1148.

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IC Document
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#32: Provider-Preventable Conditions under 42 CFR 438.6 and 447.26 and Title 2702 Non-Payment Preprint (Attachment 4.19) (CMS-10364)
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Instructions - Provider-Preventable Conditions (_32) [rev 7-17-2014 at 2_00 pm by OSORA PRA].docx No   Printable Only
Form CMS-10398 (#32) Pre-print Provider-Preventable Conditions Pre-Print - Provider-Preventable Conditions (_32) [rev 7-17-2014 at 2_00 pm by OSORA PRA].docx Yes Yes Fillable Printable

Health Health Care Services

 

2 0
   
State, Local, and Tribal Governments
 
   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 2 0 2 0 0 0
Annual IC Time Burden (Hours) 78 0 78 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#32 Supporting Statement: Provider-Preventable Conditions and Non-Payment Preprint (Attachment 4.19) (CMS-10364) #32 Supporting Statement - Provider-Preventable Conditions [Dec 2014].docx 12/23/2014
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