Information Collection

Ambulatory Surgical Centers Conditions of Coverage 416.52(a)

IC 233417 under ICR 202405-0938-029 · OMB 0938-1071.

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IC Title:

Ambulatory Surgical Centers Conditions of Coverage 416.52(a)

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 416.52(a)

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: 75

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	75	-5,482	5,557
Annual IC Time Burden (Hours)	2,248	-55,032	57,280
Annual IC Cost Burden (Dollars)	0	0	0

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