Physicians' Referrals to Health Care Entitles With Which They Have Financial Relationships and Supporting Regulations in 42 CFR, Sections 411.352, 411.354,411.355,411.357 and 411.361

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IC Title:	Physicians' Referrals to Health Care Entitles With Which They Have Financial Relationships and Supporting Regulations in 42 CFR, Sections 411.352, 411.354,411.355,411.357 and 411.361	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 411.361 42 CFR 411.352(d) 42 CFR 411.354(d) 42 CFR 411.355(e) 42 CFR 411.357(a)(b)(d)(e)(h)(l)(p)(s

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: 154,404	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	154,404	0	91,580	62,824
Annual IC Time Burden (Hours)	116,035	-230,096	-75,877	422,008
Annual IC Cost Burden (Dollars)	0	0	0	0

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