Conflict of Interest and Ownership and Control Informaiton

Documents and Forms

Document Name Document Type
Form CMS-R-312 Conflict of Interest and Ownership and Control Informaiton Form and Instruction
CMS-R-312 Conflict of Interest and Ownership and Control Informati CMS-R-312.Collection Instrument.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Conflict of Interest and Ownership and Control Informaiton	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	CMS-R-312	Conflict of Interest and Ownership and Control Information Statement	CMS-R-312.Collection Instrument.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 37	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	37	37
Annual IC Time Burden (Hours)	11,100	11,100
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.