Information Collection

Indirect Medical Education (IME) And Supporting Regulations 42 CFR 412.105

IC 8077 under ICR 200009-0938-011 · OMB 0938-0456.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0456 can be found here:

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Information Collection (IC) Details

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IC Title:	Indirect Medical Education (IME) And Supporting 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: 1,350	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	1,350	50	1,300
Annual IC Time Burden (Hours)	2,700	-550	3,250
Annual IC Cost Burden (Dollars)	0	0	0

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