QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 412.44, 412.46, 431.630, 476.71, 476.74, 476.78

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IC Title:	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 412.44, 412.46, 431.630, 476.71, 476.74, 476.78	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-71				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,036	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	Previously Approved
Annual Number of Responses for this IC	6,036	6,036
Annual IC Time Burden (Hours)	81,818	81,818
Annual IC Cost Burden (Dollars)	0	0

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Title	Document	Date Uploaded

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