Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)

Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)

OMB: 0938-1009

IC ID: 45538

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Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 411.357(v) 42 CFR 411.357(w)

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

Health Health Care Services

 

150 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   35 %

  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 150 0 0 0 0 150
Annual IC Time Burden (Hours) 225 0 0 0 0 225
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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