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End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration and Supporting Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts....

IC 7806 under ICR 202402-0938-004 · OMB 0938-0046.

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End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration and Supporting Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts....
 
No Modified
 
Mandatory
 
42 CFR 405.2133

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-2728 ESRD Medical Evidence Report CMS-2728 508 SOGI revisions- clean.docx Yes Yes Fillable Fileable

Health Health Care Services

 

7,828 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 138,000 0 0 0 0 138,000
Annual IC Time Burden (Hours) 172,500 0 0 0 0 172,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-2728 Redline CMS-2728 508 SOGI revisions- redline.docx 02/09/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.