Information Collection

Physician Financial Interest In Clinical Laboratories Survey Form

IC 114039 under ICR 199206-0938-011 · OMB 0938-0586.

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Information Collection (IC) Details

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IC Title:	PHYSICIAN FINANCIAL INTEREST IN CLINICAL LABORATORIES SURVEY FORM	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-96				No	No
Form	97				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	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	3,000	-317,000	320,000
Annual IC Time Burden (Hours)	2,250	-157,750	160,000
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.