Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare Program

(CMS-29) Request for Certification as Rural Health Clinic Form and Supporting Regulations

OMB: 0938-0074

IC ID: 7832

Information Collection (IC) Details

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Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare Program
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-29 Verification of Clinic Data - Rural Health Clinic Program CMS-29 form (08-17-2018).pdf No   Printable Only

Health Health Care Services

 

210 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 210 0 0 -690 0 900
Annual IC Time Burden (Hours) 70 0 0 -80 0 150
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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