Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)

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IC Title:	Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 424.36(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,402	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	14,155,617	-1,478,164	15,633,781
Annual IC Time Burden (Hours)	1,180,578	-123,279	1,303,857
Annual IC Cost Burden (Dollars)	0	0	0

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