Information Collection

(CMS-R-290) Medicare Program: Revised Procedures for Making National Coverage Determinations

IC 8526 under ICR 201608-0938-014 · OMB 0938-0776.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0776 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-R-290 (CMS-R-290) Medicare Program: Revised Procedures for Making National Coverage Determinations Form and Instruction
CMS-R-290 CMS-R-290 Collection Requirements CMS-R-290.Instrument (Reporting Requirements).doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	(CMS-R-290) Medicare Program: Revised Procedures for Making National Coverage Determinations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-290	CMS-R-290 Collection Requirements	CMS-R-290.Instrument (Reporting Requirements).doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30	-170	200
Annual IC Time Burden (Hours)	1,200	-6,800	8,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.