Information Collection

(CMS-R-240) Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.65

IC 8576 under ICR 201902-0938-006 · OMB 0938-0798.

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Information Collection (IC) Details

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IC Title:	(CMS-R-240) Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.65	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 413.65

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: 1,832	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	13,648,400	13,147,945	500,455
Annual IC Time Burden (Hours)	682,420	655,857	26,563
Annual IC Cost Burden (Dollars)	0	0	0

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