Attestation

Medicare Fee-for-Service Early Review of Medical Records

OMB: 0938-0969

IC ID: 201492

Documents and Forms
Document Name
Document Type
Instruction
Information Collection (IC) Details

View Information Collection (IC)

Attestation
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 421.200 42 CFR 421.210 42 CFR 421.304

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction PIM ADR color coded.doc Yes No Printable Only

Health Health Care Services

 

31,800 0
   
Individuals or Households
 
   0 %

  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 31,800 0 0 11,366 0 20,434
Annual IC Time Burden (Hours) 7,950 0 0 2,841 0 5,109
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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