Prior Authorization

Medicare Fee-for-Service Early Review of Medical Records (CMS-10417)

OMB: 0938-0969

IC ID: 231846

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Information Collection (IC) Details

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Prior Authorization
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 421.304 42 CFR 421.200 42 CFR 421.210

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

Health Health Care Services

 

46,700 0
   
Individuals or Households
 
   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 46,700 0 0 46,700 0 0
Annual IC Time Burden (Hours) 23,350 0 0 23,350 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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