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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
CMS-R-64.Instructions.pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 412.105

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-R-64.Instructions.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,215	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Farms

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,215	-10	1,225
Annual IC Time Burden (Hours)	2,430	-20	2,450
Annual IC Cost Burden (Dollars)	0	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.