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: 0938-0679	ICR Reference No: 201410-0938-004
Status: Historical Active	Previous ICR Reference No: 201303-0938-018
Agency/Subagency: HHS/CMS	Agency Tracking No: 19199
Title: Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/13/2014
	Date Received in OIRA: 10/09/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	06/30/2016	06/30/2016
Responses	462,000	0	462,000
Time Burden (Hours)	92,400	0	92,400
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): US Code: 42 USC 1395j(5) Name of Law: Special Payment Rules for Particular Items and Services
   US Code: 42 USC 1395l(e) Name of Law: Information for Determination of Amounts Due
   US Code: 42 USC 1395m(j)(2) Name of Law: Certificates of Medical Necessity
   US Code: 42 USC 1395m(j)(2)(A)(iii) Name of Law: Penalty
   US Code: 42 USC 1395y(a)(1)(A) Name of Law: Items or Services Specifically Excluded
   US Code: 42 USC 1395y(a) Name of Law: Items or Services Specifically Excluded
   US Code: 42 USC 1395x(n) Name of Law: Durable medical equipment

Citations for New Statutory Requirements: None

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