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Federal forms, ICRs, and supporting documents

Information Collection

Recognition of pass-through payment for additional (new) categories of devices under the Outpatient Prospective Payment System and Supporting Regulations (CMS-10052)

IC 8672 under ICR 202511-0938-009 · OMB 0938-0857.

Documents and Forms
Document Name
Document Type
Instruction
Information Collection (IC) Details

View Information Collection (IC)

Recognition of pass-through payment for additional (new) categories of devices under the Outpatient Prospective Payment System and Supporting Regulations (CMS-10052) CM-FFS
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 419.66

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Device Pass-through Paper Application Overview 8.5.25.docx Yes Yes Fillable Fileable

Health Health Care Services

 

16 2
   
Private Sector Businesses or other for-profits
 
   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 16 0 6 0 0 10
Annual IC Time Burden (Hours) 256 0 96 0 0 160
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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