Information Collection

Conflict of Interest and Ownership and Control Informaiton

IC 8570 under ICR 200709-0938-013 · OMB 0938-0795.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-312 Conflict of Interest and Ownership and Control Information Statement 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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-312				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 %

table that charts list of burden
	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

table that charts IC Documents
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.

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