Legal Review

Medicare Self-Referral Disclosure Protocol

OMB: 0938-1106

IC ID: 194182

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Legal Review
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10328 Medicare Self-Referral Disclosure Protocol SRDP_Protocol.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

100 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 100 0 50 0 0 50
Annual IC Time Burden (Hours) 4,000 0 3,250 0 0 750
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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