Payment for RHC and FQHC Services (sec. 405.2462(g)(3))

Rural Health Clinics (RHCs) Reporting of Healthcare Common Procedure Coding System (HCPCS) and Other Codes as Required for RHC Claims and Supporting Regulations (CMS-10568)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1287 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Payment for RHC and FQHC Services (sec. 405.2462(g)(3))	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 405.2462(g)(3)

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: 4,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 98 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	8,964,208	8,964,208
Annual IC Time Burden (Hours)	522,912	522,912
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.