PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Request for Medicare Payment
Modified
1
1
0
Form and Instruction
G-740S (03-13)
Patient's Request for Medicare Payment
Form and Instruction
CMS-1500 (02-12)
Health Insurance Claim Form
Total burden requested under this ICR:
1
1
0
To view an IC, click on IC Title
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The .gov means it's official.
The site is secure.
