Information Collection

Procedures for advisory opinions concerning physician referrals and supporting regulations in 42 CFR Sections 411.370 through 411.389

IC 8365 under ICR 200709-0938-011 · OMB 0938-0714.

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IC Title:	Procedures for advisory opinions concerning physician referrals and supporting regulations in 42 CFR Sections 411.370 through 411.389	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 422.372 42 CFR 411.373

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 50

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	-150	200
Annual IC Time Burden (Hours)	1,000	-1,000	2,000
Annual IC Cost Burden (Dollars)	0	-400,000	400,000

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