Information Collection Request

Appropriate Use Criteria for Advanced Diagnostic Imaging Services (CMS-10570)

ICR 202010-0938-012 · OMB 0938-1288 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-10570 - Supporting Statement A CLEAN 06.16.20.doc.docx Supporting Statement A Uploaded 2020-10-29 Repair queued

IC Document Collections

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
10 0
150 0
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Re-Application to be Recognized as a Qualified Provider-led Entity (sec. 414.94)
Application to be Recognized as a Qualified Provider-led Entity (sec. 414.94)

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 10 0 0 -30 -20 60
Annual Time Burden (Hours) 150 0 0 -900 -300 1,350
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No