Information Collection

42 CFR 489.20(u)(1) - Attestation of non-Referring Status (Attorney)

IC 186811 under ICR 201707-0938-011 · OMB 0938-1034.

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Information Collection (IC) Details

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IC Title:	42 CFR 489.20(u)(1) - Attestation of non-Referring Status (Attorney)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 489.20(u)(2)

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: 81	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	81	54	27
Annual IC Time Burden (Hours)	81	54	27
Annual IC Cost Burden (Dollars)	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.