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Triage--coordinated Care Of The Elderly (billing Forms)
TRIAGE--COORDINATED CARE OF THE ELDERLY (BILLING FORMS)
OMB: 0938-0167
IC ID: 113017
OMB.report
HHS/CMS
OMB 0938-0167
ICR 198104-0938-005
IC 113017
( )
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:
TRIAGE--COORDINATED CARE OF THE ELDERLY (BILLING FORMS)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HCFA-269
No
No
Form
THRU 274
No
No
Form
-HCFA-1453D,
No
No
Form
1483D,
No
No
Form
1487D,
No
No
Form
1490D &
No
No
Form
1491D
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,458
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
44,115
0
44,115
0
0
0
Annual IC Time Burden (Hours)
3,725
0
3,725
0
0
0
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.