Application to be Recognized as a Qualified Provider-led Entity (sec. 414.94)

Appropriate Use Criteria for Advanced Diagnostic Imaging Services (CMS-10570)

OMB: 0938-1288

IC ID: 217369

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Application to be Recognized as a Qualified Provider-led Entity (sec. 414.94)
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 414.94(c)(1) and (2)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

30 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 30 30 0 0 0 0
Annual IC Time Burden (Hours) 900 900 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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