CMS-R-10 Form 83 - Part II (Developing Advanced Directive)

(CMS-R-10) Advanced Directives (Medicare and Medicard)

OMB: 0938-0610

IC ID: 189098

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CMS-R-10 Form 83 - Part II (Developing Advanced Directive)
 
No Removed
 
Mandatory
 
42 CFR 489.102(a)(2) 42 CFR 417.436(d)(iii) 42 CFR 422.128

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

Health Health Care Services

 

2,276 0
   
Private Sector Businesses or other for-profits
 
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  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 0 -2,276 0 2,276
Annual IC Time Burden (Hours) 0 0 0 -2,276 0 2,276
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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