Accepting New Patients Indicator UPIN (Unique Physician Identifi- cation Number) Participating Physicians Directory

Accepting New Patients Indicator UPIN (Unique Physician Identification Number) Participating Physicians Directory

Documents and Forms

Document Name Document Type
CMS-10091 accepting new pts template.doc Other-Template

Information Collection (IC) Details

IC Title:	Accepting New Patients Indicator UPIN (Unique Physician Identifi- cation Number) Participating Physicians Directory	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Template			CMS-10091 accepting new pts template.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,980	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	10,980	10,980
Annual IC Time Burden (Hours)	915	915
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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