Information Collection

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

IC 217367 under ICR 201511-0938-006 · OMB 0938-1287.

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Information Collection (IC) Details

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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: Unchanged

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 %

	Approved	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

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