OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT AND MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT (NEW PHYSICIANS SUPPLIERS)

ICR 198409-0938-017 · OMB 0938-0373 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
166274 MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT AND MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT (NEW PHYSICIANS SUPPLIERS) Form Migrated
ICR Details
0938-0373 198409-0938-017
Historical Active 198407-0938-004
HHS/CMS
MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT AND MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT (NEW PHYSICIANS SUPPLIERS)
No material or nonsubstantive change to a currently approved collection   No
Emergency 09/28/1984
Approved with change 09/28/1984
Retrieve Notice of Action (NOA) 09/28/1984
  Inventory as of this Action Requested Previously Approved
08/31/1986 08/31/1986 08/31/1986
272,880 0 272,880
43,661 0 43,661
0 0 0
THE HCFA-460 REQUIRES ALL PHYSICIANS/SUPPLIERS TO SELECT OR DECLINE PARTICIPATION IN MEDICARE. THESE TWO GROUPINGS ARE THE BASIS FOR UPDATING REASONABLE CHARGE SCREENS AND ANNUAL PUBLICATION OF A DIRECTORY OF PARTICIPATING PHYSICIANS AND SUPPLIERS. THOSE PHYSICIANS SUPPLIERS CHOOSING TO PARTICIPATE IN MEDICARE AGREE TO ACCEPT REIMBURSEMENT ON A REASONABLE CHARGE BASIS.
None
None
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 272,880 272,880 0 0 0 0
Annual Time Burden (Hours) 43,661 43,661 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/28/1984