Indirect Medical Education (IME) and Supporting Regulations 42 CFR 412.105

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0456 can be found here:

Documents and Forms

Document Name Document Type
CMS-R-64.Attachment1 - Instructions.doc Instruction
CMS-R-64.Attachment2.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Indirect Medical Education (IME) and Supporting Regulations 42 CFR 412.105	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 412.105

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-R-64.Attachment1 - Instructions.doc		Yes	Yes	Fillable Fileable
Instruction			CMS-R-64.Attachment2.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,190	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Farms

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,190	-25	1,215
Annual IC Time Burden (Hours)	2,380	-50	2,430
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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