Information Collection

Information Collection Requirement In Hsq-109-f, Peer Review Organization Sanctions, 42 Cfr 1004.40(b), 1004.50(a), (b) And (c), 1004.60(a) And (b), 1004.70(a) And (b)

IC 113742 under ICR 198908-0938-010 · OMB 0938-0444.

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENT IN HSQ-109-F, PEER REVIEW ORGANIZATION SANCTIONS, 42 CFR 1004.40(B), 1004.50(A), (B) AND (C), 1004.60(A) AND (B), 1004.70(A) AND (B)	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-65				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	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	Previously Approved
Annual Number of Responses for this IC	1,080	1,080
Annual IC Time Burden (Hours)	30,672	30,672
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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