Submitting a Prior Authorization Request and Mailing Medical Records

Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (CMS-10524)

OMB: 0938-1293

IC ID: 212039

Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details

View Information Collection (IC)

Submitting a Prior Authorization Request and Mailing Medical Records
 
No Modified
 
Mandatory
 
42 CFR 414.234(c)

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

Health Health Care Services

 

273,305 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 273,305 0 0 -48,246 0 321,551
Annual IC Time Burden (Hours) 136,652 0 0 -24,124 0 160,776
Annual IC Cost Burden (Dollars) 4,816,039 0 0 -344,858 0 5,160,897

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy