QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.73 (QIO Burden)

QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 412.44, 412.46, 431.630, 476.71, 476.74, 476.78

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Documents and Forms

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no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.73 (QIO Burden)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 476.73

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: 60	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
Annual Number of Responses for this IC	6,036	6,036
Annual IC Time Burden (Hours)	623	623
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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