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Claims Data and Other Record Reports Preparation (42 CFR 456.709)

IC 196901 under ICR 202501-0938-007 · OMB 0938-0659.

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Claims Data and Other Record Reports Preparation (42 CFR 456.709)
 
No Unchanged
 
Mandatory
 
42 CFR 456.709

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

Health Health Care Services

 

52 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 208 0 0 0 0 208
Annual IC Time Burden (Hours) 1,040 0 0 0 0 1,040
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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