View Information Collection Request (ICR) Package

OMB Control No: 0938-0679	ICR Reference No: 199510-0938-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity, Version I and Version II
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 10/11/1995
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/12/1995
	Date Received in OIRA: 10/11/1995
Terms of Clearance: Approved for emergency use through 1/9/96 with the understanding that during the next three months, HCFA will consult with the affected public, and HCFA and OMB thoroughly will consider public comments recommending alternative CMNs and less burdensome approaches to protecting the Medicare Trust Fund from fraudulent and abusive billing practices. This review period may lead to revisions to the CMNs and an information collection approach targeted toward suppliers, physicians, and DME categories most likely to engage in such practices.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/1996	01/31/1996
Responses	6,800,000	0	0
Time Burden (Hours)	1,130,000	0	0
Cost Burden (Dollars)	0	0	0

Abstract: This information is needed to correctly process claims and insure that claims are properly paid. These forms contain medical information necessary to make an appropriate determination. Suppliers and physicians will complete these forms.

Emergency Justfication:

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity, Version I and Version II	HCFA-R-182

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	6,800,000	6,800,000
Annual Time Burden (Hours)	1,130,000	1,130,000
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

View ICR - OIRA Conclusion