OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medicare Non-utilization Project (MNUP) - Field Office Interview

IC 280097 under ICR 202603-0960-012 · OMB 0960-0780.

Documents and Forms
Document Name
Document Type
Other-Interview Worksheet
Other-Interview Worksheet
Information Collection (IC) Details

View Information Collection (IC)

Medicare Non-utilization Project (MNUP) - Field Office Interview
 
No New
 
Required to Obtain or Retain Benefits
 
20 CFR 416.204(b) 20 CFR 422.135

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Interview Worksheet Face-to-Face Interview Worksheet.pdf Yes No Printable Only
Other-Interview Worksheet MNUP Worksheet Screen Shots.pdf Yes No Printable Only

Income Security General Retirement and Disability

 

1,125 0
   
Individuals or Households
 
   0 %

  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 1,125 0 0 1,125 0 0
Annual IC Time Burden (Hours) 1,350 0 0 1,350 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].