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42 CFR 489.20(w)(4) Receive patient signature on written notice of lack of MD coverage

IC 247551 under ICR 202105-0938-008 · OMB 0938-1034.

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Information Collection (IC) Details

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

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested 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 2,331,817 0 0 2,331,817 0 0
Annual IC Time Burden (Hours) 38,864 0 0 38,864 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.