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Application for Hospital Insurance Benefits Medicare for Individuals with End Stage Renal Disease and Supporting Regulations in 42 CFR 406.7 and 406.13

IC 7835 under ICR 202407-0938-001 · OMB 0938-0080.

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Application for Hospital Insurance Benefits Medicare for Individuals with End Stage Renal Disease and Supporting Regulations in 42 CFR 406.7 and 406.13
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 406.13 42 CFR 406.7

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-43 Application for Hospital Insurance Benefits for Individuals with End Stage Renal Disease Redesigned CMS-43_508.pdf No   Fillable Printable

Health Health Care Services

 

45,200 0
   
Individuals or Households
 
   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 45,200 0 0 24,818 20,382 0
Annual IC Time Burden (Hours) 18,984 0 0 10,424 8,560 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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