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Prior Authorization
Medicare Fee-for-Service Early Review of Medical Records (CMS-10417)
OMB: 0938-0969
IC ID: 231846
OMB.report
HHS/CMS
OMB 0938-0969
ICR 201806-0938-001
IC 231846
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0969 can be found here:
2021-10-13 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Prior Authorization
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
42 CFR 421.304
42 CFR 421.200
42 CFR 421.210
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
46,700
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
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.