OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Notice of Right to Good Faith Estimate – Wholly Physician-Owned Private Practices

IC 249568 under ICR 202109-0938-015 · OMB unassigned.

Documents and Forms
Document Name
Document Type
Other-Data Elements
Information Collection (IC) Details

View Information Collection (IC)

Notice of Right to Good Faith Estimate – Wholly Physician-Owned Private Practices
 
No New
 
Mandatory
 
45 CFR 149.610

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Data Elements 11. HHS - Appendix Good Faith Estimate Data Elements.pdf Yes No Paper Only

Health Health Care Services

 

120,525 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   5 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 120,525 120,525 0 0 0 0
Annual IC Time Burden (Hours) 421,838 421,838 0 0 0 0
Annual IC Cost Burden (Dollars) 50,649,426 50,649,426 0 0 0 0

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.