Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System

Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System (CMS-10175)

OMB: 0938-0984

IC ID: 43676

Information Collection (IC) Details

View Information Collection (IC)

Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10175 EFI Certification Statement CMS-10175 - ELECTRONIC FILE INTERCHANGE ORGANIZATION (EFIO).docx Yes No Fillable Fileable

Health Health Care Services

 

21 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 21 0 0 -4 25 0
Annual IC Time Burden (Hours) 5 0 0 -70 75 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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