Pharmacy Billing Requirements

Pharmacy Billing Requirements

OMB: 1240-0050

IC ID: 38474

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Pharmacy Billing Requirements
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.705 20 CFR 10.801 20 CFR 30.701 20 CFR 725.701

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Instructions for Required Data Elements for Pharmacy Bills (for 2012).pdf Yes Yes Printable Only

Health Health Care Services

DOL/GOVT-1 (FECA); DOL/ESA-6 (BLBA); DOL/ESA-49 (EEOICPA)  67 FR 16826

4,344 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   98 %

  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 1,453,300 0 0 -36,232 0 1,489,532
Annual IC Time Burden (Hours) 24,421 0 0 -2,496 0 26,917
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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