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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Medicare Geographic Classification Review Board (MGCRB) Procedures and Criteria and Supporting Regulations in 42 CFR, Section 412.256 & 412.230 (CMS-R-138)
Modified
300
300
0
Form
CMS-R-138
Statewide Application
Form
CMS-R-138
Statewide Affidavit
Form
CMS-R-138
Individual Application
Form
CMS-R-138
Individual - Special Access (Driving Time)
Form
CMS-R-138
Individual - Special Access (Distance)
Form
CMS-R-138
Individual - Proximity (Employee Commuting Pattern)
Form
CMS-R-138
Individual - Proximity (Distance)
Form and Instruction
CMS-R-138
Group Application
Other-Board Rules
Total burden requested under this ICR:
300
300
0
To view an IC, click on IC Title
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