State or National Organizations -- Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records

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

OMB: 0938-1009

IC ID: 45538

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Information Collection (IC) Details

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State or National Organizations -- Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 411.357(v) 42 CFR 411.357(w)

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

Health Health Care Services

 

75 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 75 0 0 -75 150 0
Annual IC Time Burden (Hours) 113 0 0 -112 225 0
Annual IC Cost Burden (Dollars) 0 0 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.

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