Medicare Participating Physician Or Supplier Agreement And Medicare Participating Physician Or Supplier Agreement (new Physicians Suppliers)

MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT AND MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT (NEW PHYSICIANS SUPPLIERS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0373 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT AND MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT (NEW PHYSICIANS SUPPLIERS)	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-460				No	No
Form	463				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 272,880	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	272,880	272,880
Annual IC Time Burden (Hours)	43,661	43,661
Annual IC Cost Burden (Dollars)	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.