Information Collection

42 CFR 485.66(b)(1), (2), and 3(i),(ii) Untilization review plan

IC 192450 under ICR 201810-0938-009 · OMB 0938-1091.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1091 can be found here:

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Information Collection (IC) Details

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IC Title:	42 CFR 485.66(b)(1), (2), and 3(i),(ii) Untilization review plan	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 485.66(b)(3)(i)(ii) 42 CFR 485.66(b)(1)(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: 188	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	188	-47	235
Annual IC Time Burden (Hours)	1,504	-1,551	3,055
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.