Information Collection

Information Collection Requirements In Hsq-110, Acquisition, Protection And Disclosure Of Peer Review Organization Information -- 42 Cfr Sections 476.104, 476.105, 476.116, And

IC 113694 under ICR 199306-0938-001 · OMB 0938-0426.

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENTS IN HSQ-110, ACQUISITION, PROTECTION AND DISCLOSURE OF PEER REVIEW ORGANIZATION INFORMATION -- 42 CFR SECTIONS 476.104, 476.105, 476.116, AND	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-70				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	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
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	30,577	30,577
Annual IC Cost Burden (Dollars)	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.