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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.