End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration and Supporting Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts....

End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration (CMS-2728)

OMB: 0938-0046

IC ID: 7806

Information Collection (IC) Details

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End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration and Supporting Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts....
 
No Modified
 
Mandatory
 
42 CFR 405.2133

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-2728 ESRD Medical Evidence Report Form CMS-2728_508.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

7,311 0
   
Private Sector Businesses or other for-profits
 
   100 %

  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 138,000 0 8,000 0 130,000 0
Annual IC Time Burden (Hours) 103,500 0 6,000 0 97,500 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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