Information Collection

QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.78(b)(3)

IC 185531 under ICR 201702-0938-015 · OMB 0938-0445.

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Information Collection (IC) Details

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IC Title:	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.78(b)(3)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 476.78

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: 6,939	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,939	6,939
Annual IC Time Burden (Hours)	1,157	1,157
Annual IC Cost Burden (Dollars)	0	0

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