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Medicare Physician Survey Form

IC 114076 under ICR 199308-0938-002 · OMB 0938-0615.

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Information Collection (IC) Details

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MEDICARE PHYSICIAN SURVEY FORM
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA 412 No No
Form (FORMERLY No No
Form HCFA-R-15) No No


    

22,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 22,000 0 22,000 0 0 0
Annual IC Time Burden (Hours) 5,500 0 5,500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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