Information Collection

Medical Records Review under PPS and Supporting Regulations at 42 CFR 412.40-412.52

IC 7998 under ICR 199812-0938-011 · OMB 0938-0359.

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Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Medical Records Review under PPS and Supporting Regulations at 42 CFR 412.40-412.52

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-50				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,053

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	895,419	148,738	746,681
Annual IC Time Burden (Hours)	26,865	4,465	22,400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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

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