ICR Req's in HSQ-110, Acquisition, Protection and Disclosure of PRO Information and Supporting Regulations in 42 CFR 476.104, 476.105, 476.116, 476.134

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Information Collection (IC) Details

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IC Title:	ICR Req's in HSQ-110, Acquisition, Protection and Disclosure of PRO Information and Supporting Regulations in 42 CFR 476.104, 476.105, 476.116, 476.134	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

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-70				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 362	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	3,729	3,729
Annual IC Time Burden (Hours)	60,919	60,919
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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