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Medicare Common Claims Form

IC 162194 under ICR 198802-9999-001 · OMB 9999-0014.

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MEDICARE COMMON CLAIMS FORM
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-1500 No No
Form 1490S, No No
Form 1490U No No


    

326,110,000 0
   
Individuals or Households
 
   0 %

  Approved 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 326,109,999 0 0 326,109,999 0 0
Annual IC Time Burden (Hours) 58,623,706 0 0 58,623,706 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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