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

Documents and forms in this information collection
Document Name	Document Type
CMS Response to Public Comments4-13-26.docx Response to public comment	IC Document

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Response to public comment		04/21/2026

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].