Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records-Donor and Representative Negotiation(CMS-10207)

Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1009 can be found here:

Documents and Forms

Document Name Document Type

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

Information Collection (IC) Details

IC Title:	Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records-Donor and Representative Negotiation(CMS-10207)	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 411.357(v) 42 CFR 411.357(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: 374	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,496	-24,744	26,240
Annual IC Time Burden (Hours)	2,992	-3,568	6,560
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.