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Federal forms, ICRs, and supporting documents

Information Collection

Suppliers that Choose Not to Grandfather - Round 2 (10-Day and 2-Day Notifications)

IC 207249 under ICR 201608-0938-007 · OMB 0938-1079.

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

View Information Collection (IC)

Suppliers that Choose Not to Grandfather - Round 2 (10-Day and 2-Day Notifications)
 
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 Letter Sample Letter to Beneficiary from Supplier that Chooses NOT to Grandfather CLEAN 508.pdf No No Fillable Printable

Health Health Care Services

 

694 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 -57,833 0 0 57,833
Annual IC Time Burden (Hours) 0 0 -28,917 0 0 28,917
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.