Electronic Funds Transfer Authorization Agreement

Electronic Funds Transfer Authorization Agreement (CMS-588)

OMB: 0938-0626

IC ID: 43660

Information Collection (IC) Details

View Information Collection (IC)

Electronic Funds Transfer Authorization Agreement
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-588 Electronic Funds Transfer CMS-588 - Electronic Funds Transfer Form.pdf Yes Yes Fillable Fileable

Health Health Care Services

Provider Enrollment, Chain and Ownership System: SORN number 09-70-0532   83 FR 6591

82,807 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 82,807 0 0 -33,026 0 115,833
Annual IC Time Burden (Hours) 56,037 0 0 -1,880 0 57,917
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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