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.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0359 can be found here:

Documents and Forms

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Information Collection (IC) Details

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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:

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 %

	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

Title	Document	Date Uploaded

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