Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)

Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b) (CMS-10242)

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Information Collection (IC) Details

IC Title:	Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)	Agency IC Tracking Number:	CM-FFS

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 424.36(b)

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,229	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	13,318,440	-837,177	14,155,617
Annual IC Time Burden (Hours)	1,110,757	-69,821	1,180,578
Annual IC Cost Burden (Dollars)	0	0	0

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