Procedures for Advisory Opinions Concerning Physician Referrals and Supporting Regulations -- Sections 411.370 through 411.389

ICR 199801-0938-002

OMB: 0938-0714

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0714 199801-0938-002
Historical Active
HHS/CMS
Procedures for Advisory Opinions Concerning Physician Referrals and Supporting Regulations -- Sections 411.370 through 411.389
New collection (Request for a new OMB Control Number)   No
Emergency 01/14/1998
Approved without change 01/13/1998
Retrieve Notice of Action (NOA) 01/12/1998
  Inventory as of this Action Requested Previously Approved
07/31/1998 07/31/1998
200 0 0
2,000 0 0
0 0 0

A request must include a complete description of the situation that is the subject of the advisory opinion and must include copies of all relevant documents or relevant portions, such as financial statements, contracts, leases, employment agreements, and court documents. The submission must include the identities and addresses of all known actual and potential parties to the arrangement. A request for an advisory opinion is purely voluntary. The facts will relate to business plans, and the requestor will already have collected and analyzed all or almost all of the information we will need to review the request.

None
None


No

1
IC Title Form No. Form Name
Procedures for Advisory Opinions Concerning Physician Referrals and Supporting Regulations -- Sections 411.370 through 411.389 HCFA-R-216

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 200 0 0 200 0 0
Annual Time Burden (Hours) 2,000 0 0 2,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/12/1998


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