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Summary Fraud And Abuse Report Forms
SUMMARY FRAUD AND ABUSE REPORT FORMS
OMB: 0938-0077
IC ID: 166147
OMB.report
HHS/CMS
OMB 0938-0077
ICR 197808-0938-008
IC 166147
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0077 can be found here:
1981-11-20 - Revision of a currently approved collection
1981-07-28 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SUMMARY FRAUD AND ABUSE REPORT FORMS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HCFA-52THRU5
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
636
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
636
0
0
0
0
636
Annual IC Time Burden (Hours)
1,272
0
0
0
0
1,272
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.