OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Suppliers that Choose to Grandfather - Round 2 (30-Day Notification to Beneficiary)

IC 207245 under ICR 201608-0938-007 · OMB 0938-1079.

Documents and Forms
Document Name
Document Type
Other-Sample Notice
Information Collection (IC) Details

View Information Collection (IC)

Suppliers that Choose to Grandfather - Round 2 (30-Day Notification to Beneficiary)
 
No Removed
 
Mandatory
 
42 CFR 414.408(j)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Sample Notice Sample Letter to Beneficiary from Supplier that Chooses to Grandfather CLEAN 508.pdf No No Fillable Printable

Health Health Care Services

 

6,248 0
   
Private Sector Businesses or other for-profits
 
   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 0 0 -520,667 0 0 520,667
Annual IC Time Burden (Hours) 0 0 -43,736 0 0 43,736
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.