Information Collection

(CMS-R-290) Medicare Program: Revised Procedures for Making National Coverage Determinations

IC 8526 under ICR 202412-0938-002 · OMB 0938-0776.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-290 (CMS-R-290) Medicare Program: Revised Procedures for Making National Coverage Determinations	Form and Instruction
Form CMS-R-290 CMS-R-290 Collection Requirements (CMS-R-290) Medicare Program: Revised Procedures for Making National Coverage Determinations	Form and Instruction
CMS-R-290 CMS-R-290 Collection Requirements CMS-R-290.Instrument (Reporting Requirements).doc	Form and Instruction
CMS-R-290 CMS-R-290 Collection Requirements CMS-R-290.Instrument (Reporting Requirements).doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-290				No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	1,200	1,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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