Information Collection

Info. Collection Req'mts. In 42 Cfr Part 405.1722, 1736 Conditions Of Participation For Outpatient Clinics 405.1716, 405.1717, 405.1720, 405.1721

IC 113452 under ICR 198406-0938-010 · OMB 0938-0336.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0336 can be found here:

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Information Collection (IC) Details

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IC Title:	INFO. COLLECTION REQ'MTS. IN 42 CFR PART 405.1722, 1736 CONDITIONS OF PARTICIPATION FOR OUTPATIENT CLINICS 405.1716, 405.1717, 405.1720, 405.1721	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-44				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	753	752	1
Annual IC Time Burden (Hours)	2,883	2,882	1
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.