Indirect Medical Education (IME) and Supporting Regulations 42 CFR 412.105

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0456 can be found here:

Documents and Forms

Document Name Document Type
CMS-R-64.Attachment2 - Jul2016.pdf Instruction
CMS-R-64.Attachment1 - Jul2016.pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Indirect Medical Education (IME) and Supporting Regulations 42 CFR 412.105	Agency IC Tracking Number:	CMS-R-64

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 412.105

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-R-64.Attachment2 - Jul2016.pdf		Yes	Yes	Fillable Printable
Instruction			CMS-R-64.Attachment1 - Jul2016.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,245	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,245	55	1,190
Annual IC Time Burden (Hours)	2,490	110	2,380
Annual IC Cost Burden (Dollars)	0	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.