Information Collection

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

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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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:

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: 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 %

table that charts list of burden
	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

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.

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