Information Collection

On-going Burden

IC 244741 under ICR 202412-0938-005 · OMB 0938-1412.

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Information Collection (IC) Details

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IC Title:	On-going Burden	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 457.730 42 CFR 457.760 42 CFR 457.1233(d)(2) and (3) 42 CFR 156.221 42 CFR 422.119 42 CFR 422.120 42 CFR 431.60 42 CFR 431.70 42 CFR 438.242(b)(5) and (6)

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: 345	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	345	345
Annual IC Time Burden (Hours)	589,950	589,950
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.