Information Collection

57.401 Outpatient Procedure - Monthly Reporting Plan

IC 208405 under ICR 201308-0920-010 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.401 57.401 Outpatient Procedure - Monthly Reporting Plan	Form
57.401 Outpatient Procedure - Monthly Reporting Plan 57.401_OPCReportPlan_BLANK.DOCX	Form
13. Outpatient Procedure Component.pdf 13	IC Document

IC Title:

57.401 Outpatient Procedure - Monthly Reporting Plan

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	57.401	Outpatient Procedure - Monthly Reporting Plan	57.401_OPCReportPlan_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	15,000	15,000
Annual IC Cost Burden (Dollars)	472,200	472,200

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
13	13. Outpatient Procedure Component.pdf	08/22/2013

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