Information Collection

42 CFR 411.362(b)(3)(ii)(C) Website/Public Advertising Disclosure

IC 195711 under ICR 201707-0938-011 · OMB 0938-1034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1034 can be found here:

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Information Collection (IC) Details

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IC Title:	42 CFR 411.362(b)(3)(ii)(C) Website/Public Advertising Disclosure	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 411.362(b)(3)(ii)(C)

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	-184	265
Annual IC Time Burden (Hours)	41	-92	133
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.