Disclosure Requirement

Disclosure Requirement for the In-Office Ancillary Services Exception

OMB: 0938-1133

IC ID: 194232

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Disclosure Requirement
 
No New
 
Mandatory
 
42 CFR 411.55(b)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

71,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,545,760 7,545,760 0 0 0 0
Annual IC Time Burden (Hours) 125,383 125,383 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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