Information Collection

Physicians (Registration)

IC 209364 under ICR 201707-0938-018 · OMB 0938-1237.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1237 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10495 Physicians (Registration) Form and Instruction
CMS-10495 Physician Registration CMS-10495 - Registration-Physicians-Hospitals-AMs-GPOs - data elements and screen sh....pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Physicians (Registration)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 403.908

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10495	Physician Registration	CMS-10495 - Registration-Physicians-Hospitals-AMs-GPOs - data elements and screen sh....pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 31,897	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	127,588	-96,837	224,425
Annual IC Time Burden (Hours)	829,322	-629,441	1,458,763
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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