Information Collection

Professional Standards Review Organization Routine Federal Reporting Requirements

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

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Information Collection (IC) Details

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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:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	121	No	No
Form	121-13	No	No
Form	135, 153	No	No
Form	SF-269	No	No
Form	HCFA-111	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 %

	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

Title	Document	Date Uploaded

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