Information Collection

Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)

IC 184092 under ICR 202604-0938-019 · OMB 0938-1049.

Documents and Forms

Document Name Document Type
CMS Response to Public Comments4-13-26.docx Response to public comment IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)	Agency IC Tracking Number:	CM-FFS

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 424.36(b)

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: 10,278	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	9,265,931	-1,688,357	10,954,288
Annual IC Time Burden (Hours)	771,852	-140,640	912,492
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Response to public comment	CMS Response to Public Comments4-13-26.docx	04/21/2026

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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