View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Notice of Provider Non-Coverage (CMS-10123) and Detailed Explanation of Non-Coverage (CMS-10124)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 405.1200 42 CFR 405.1202

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMMS-10124 Yes No Fillable Fileable
Instruction Yes No Fillable Fileable

Health Health Care Services

 

25,655 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 25,655 0 0 10,018 15,637 0
Annual IC Time Burden (Hours) 42,232 0 0 36,760 5,472 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.
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