Information Collection

Medical Records Review Under PPS and Supporting Regulations at 42 CFR 412.40-412.52

IC 8000 under ICR 200805-0938-001 · OMB 0938-0359.

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Information Collection (IC) Details

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IC Title:	Medical Records Review Under PPS and Supporting Regulations at 42 CFR 412.40-412.52	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 412.40 - 412.52

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: 6,100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	276,500	-121,000	397,500
Annual IC Time Burden (Hours)	8,280	-3,645	11,925
Annual IC Cost Burden (Dollars)	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.