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Notification of FIs and CMS of co-Located Medicare Providers and Supporting Regulations
Notification of FIs and CMS of co-located Medicare providers and Supporting Regulations in 42 CFR 412.22 and 412.533
OMB: 0938-0897
IC ID: 8729
OMB.report
HHS/CMS
OMB 0938-0897
ICR 201307-0938-028
IC 8729
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0897 can be found here:
2019-12-20 - Extension without change of a currently approved collection
2016-12-28 - Reinstatement without change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Notification of FIs and CMS of co-Located Medicare Providers and Supporting Regulations
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 412.22(e)(3)
42 CFR 412.22(h)(6)
42 CFR 412.532(i)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
25
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
25
0
0
0
0
25
Annual IC Time Burden (Hours)
6
0
0
0
0
6
Annual IC Cost Burden (Dollars)
0
0
0
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.