PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-NEW. The time required to complete this information collection is estimated to average 10 minutes per response, including the time and effort to complete this documentation which includes writing, typing, or dictating the face-to-face documentation and signing/dating the documentation. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
| File Type | application/msword |
| File Title | According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it |
| Author | HCFA Software Control |
| Last Modified By | ALEXANDRA SMILOW |
| File Modified | 2016-02-16 |
| File Created | 2016-02-16 |