Information Collection

Disclosures to Patients by Certain Hospitals and Critical Access Hospitals and Supporting Regulations in 489.20 (Outpatient)

IC 182130 under ICR 201008-0938-011 · OMB 0938-1034.

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IC Title:	Disclosures to Patients by Certain Hospitals and Critical Access Hospitals and Supporting Regulations in 489.20 (Outpatient)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 489.20(w)

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: 2,557	Number of Respondents for Small Entity: 1,307

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	44,675,904	0	926,016	43,749,888
Annual IC Time Burden (Hours)	1,116,898	387,733	0	729,165
Annual IC Cost Burden (Dollars)	0	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.