Information Collection

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

IC 113409 under ICR 198310-0938-029 · OMB 0938-0308.

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Information Collection (IC) Details

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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

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