Information Collection

Availability of Information and the Criteria for Medical Necessity Determinations (Regulated Entities)

IC 216059 under ICR 202512-0938-021 · OMB 0938-1280.

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Information Collection (IC) Details

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IC Title:	Availability of Information and the Criteria for Medical Necessity Determinations (Regulated Entities)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 457.496(e)(1) 42 CFR 438.915(a) 42 CFR 440.395(c)(1)

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 602	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	236,560	23,246	213,314
Annual IC Time Burden (Hours)	19,713	1,937	17,776
Annual IC Cost Burden (Dollars)	26,992	-39,819	66,811

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