Information Collection

Pharmacists (Fax the Documentation to the LI NET Sponsor)

IC 257781 under ICR 202301-0938-003 · OMB 0938-1441.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1441 can be found here:

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Information Collection (IC) Details

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IC Title:	Pharmacists (Fax the Documentation to the LI NET Sponsor)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.2500 - 423.2536

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: 36,722	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36,722	36,722
Annual IC Time Burden (Hours)	1,223	1,223
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.