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 166246 under ICR 198409-0938-023 · 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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA 31-35				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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	375,215	0	375,215
Annual IC Time Burden (Hours)	81,000	-17	81,017
Annual IC Cost Burden (Dollars)	0	0	0

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Title	Document	Date Uploaded

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