View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-1049	ICR Reference No: 200803-0938-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/04/2008
	Date Received in OIRA: 03/11/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2011	36 Months From Approved
Responses	6,500,000	0	0
Time Burden (Hours)	541,667	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	6,500,000	6,500,000
Annual Time Burden (Hours)	541,667	541,667
Annual Cost Burden (Dollars)	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: CMM is adding 424.36(b)(6), so that, in certain emergency ambulance transport situations, an ambulance provider or supplier may submit a claim to Medicare without the beneficiary's signature if certain documentation requirements are met.

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.