Information Collection

Physicians -- Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records

IC 45539 under ICR 201311-0938-028 · OMB 0938-1009.

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IC Title:

Physicians -- Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records

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:

table that charts list of 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: 8,335

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	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	16,670	-9,570	26,240
Annual IC Time Burden (Hours)	4,168	-2,392	6,560
Annual IC Cost Burden (Dollars)	0	0	0

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