Information Collection

Good Cause Processes (Sec. 417.460, 422.74, and 423.44)

IC 215417 under ICR 201502-0938-009 · OMB 0938-1271.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Good Cause Processes (Sec. 417.460, 422.74, and 423.44)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 417.460 42 CFR 422.74 42 CFR 423.44

Information Collection 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: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,376	8,376
Annual IC Time Burden (Hours)	4,188	4,188
Annual IC Cost Burden (Dollars)	0	0

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