Information Collection

Professional Standards Review Organization Routine Federal Reporting Requirements

IC 113379 under ICR 198307-0938-003 · OMB 0938-0298.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

IC Title:

PROFESSIONAL STANDARDS REVIEW ORGANIZATION ROUTINE FEDERAL REPORTING REQUIREMENTS

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	121-13	No	No
Form	135, 153	No	No
Form	121	No	No
Form	HCFA-111	No	No
Form	SF-269	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,197

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,197	3,197
Annual IC Time Burden (Hours)	33,320	33,320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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