Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408 Modified 331715277 38701221 0 Form CMS-R-131 Advanced Beneficiary Notice of Non-coverage
Form and Instruction CMS-R-131 Advanced Beneficiary Notice of Non-coverage Instructions
Form CMS-R-131 Advanced Beneficiary Notice of Non-coverage (Spanish Version)
Form CMS-R-131 Advanced Beneficiary Notice of Non-coverage (Chinese Version)
Form CMS-R-131 Advanced Beneficiary Notice of Non-coverage (Korean Version)
Form CMS-R-131 Advanced Beneficiary Notice of Non-coverage (Vietnamese Version)
Total burden requested under this ICR: 331715277 38701221 0  
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