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Disclosure of Financial Relationships Report ("DFRR") - Section 5006 of the DRA-CMS 10236

IC 37931 under ICR 200710-0938-003 · OMB 0938-0995.

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Document Type
Other-Report
Instruction
IC Document
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Disclosure of Financial Relationships Report ("DFRR") - Section 5006 of the DRA-CMS 10236
 
No Modified
 
Mandatory
 
42 CFR 411.361

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Report CMS-10236 Disclosure of Financial Relationship Report (DFRR)-Revised 8-31-07.xls Yes Yes Paper Only
Instruction CMS-10236 Attachment 1 - Instructions for Disclosure of Financial Relationship Report (DFRR) Revised83110am.doc Yes Yes Paper Only

Health Health Care Services

 

500 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 500 0 500 0 0 0
Annual IC Time Burden (Hours) 3,000 0 3,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10236 coverletter to 500 hospitals -- 8-30-07 3pm CMS-10236 coverletter to 500 hospitals -- 8-30-07 3pm.doc 10/04/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.