Information Collection

Face-to-Face encounter, physician's burden for form completion, Documenting Date of Certification 424.22 (annual)

IC 195704 under ICR 201703-0938-017 · OMB 0938-1083.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Face-to-Face encounter, physician's burden for form completion, Documenting Date of Certification 424.22 (annual)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 424.22(a)(1)(v)

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: 11,968

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	830,287	-2,096,133	2,926,420
Annual IC Time Burden (Hours)	13,783	-230,085	243,868
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.