Information Collection

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

IC 8078 under ICR 200310-0938-002 · OMB 0938-0456.

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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	CMS-R-64				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,225	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	1,225	-125	1,350
Annual IC Time Burden (Hours)	2,450	-250	2,700
Annual IC Cost Burden (Dollars)	0	0	0

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