Information Collection

42 CFR 489.20(w)(1)- (5)- Disclosure of Physician Owners/Investors to Staff Physicians

IC 186813 under ICR 202105-0938-008 · OMB 0938-1034.

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IC Title:

42 CFR 489.20(w)(1)- (5)- Disclosure of Physician Owners/Investors to Staff Physicians

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 489.20(w)(1)-(5)

Information Collection Instruments:

table that charts list of 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: 2,479

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-5,711,616	5,711,616
Annual IC Time Burden (Hours)	-142,791	142,791
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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