Information Collection

Indirect Medical Education (IME) and Support Regulations -- 42 CFR 412.105

IC 8076 under ICR 199710-0938-004 · OMB 0938-0456.

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Information Collection (IC) Details

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IC Title:	Indirect Medical Education (IME) and Support Regulations -- 42 CFR 412.105	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-64				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,300	50	1,250
Annual IC Time Burden (Hours)	3,250	-500	3,750
Annual IC Cost Burden (Dollars)	0	0	0

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