Information Collection

Primary Care Services Furnished by Physicians with a Specified Specialty or Subspeciality

IC 202301 under ICR 201411-0938-009 · OMB 0938-1170.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Primary Care Services Furnished by Physicians with a Specified Specialty or Subspeciality

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 447.400(a) and (b)

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: 51

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	125,970	125,970
Annual IC Time Burden (Hours)	62,985	62,985
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.