QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.74(b)

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 476.74(b)	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 476.74

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	60	60
Annual IC Time Burden (Hours)	16	16
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.