Information Collection Requirements In Prospective Payment Regulations (b&cr-263) Sections 405.476(b), 405-476(d), 405.1042(c), 405.1627, & 405.1629

INFORMATION COLLECTION REQUIREMENTS IN PROSPECTIVE PAYMENT REGULATIONS (B&CR-263) SECTIONS 405.476(B), 405-476(D), 405.1042(C), 405.1627, & 405.1629

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0308 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:	INFORMATION COLLECTION REQUIREMENTS IN PROSPECTIVE PAYMENT REGULATIONS (B&CR-263) SECTIONS 405.476(B), 405-476(D), 405.1042(C), 405.1627, & 405.1629	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-R-33	No	No
Form	R-32, R-31	No	No
Form	R-35	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 215	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	375,215	375,000	215
Annual IC Time Burden (Hours)	81,017	77,792	3,225
Annual IC Cost Burden (Dollars)	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.