OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medicare Integrity Program Organizational Conflict of Interest Disclosure Certificate and Supporting Regs at 42 CFR 421.300- 421.316

IC 8387 under ICR 200512-0938-004 · OMB 0938-0723.

Documents and Forms
Document Name
Document Type
No indexed documents/forms are available for this IC yet. A refresh has been queued.
Information Collection (IC) Details

View Information Collection (IC)

Medicare Integrity Program Organizational Conflict of Interest Disclosure Certificate and Supporting Regs at 42 CFR 421.300- 421.316
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-R-232 No No


    

11 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 11 0 0 6 0 5
Annual IC Time Burden (Hours) 2,200 0 0 1,200 0 1,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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