Information Collection

Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System

IC 43676 under ICR 202506-0938-013 · OMB 0938-0984.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10175 Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System	Form and Instruction
Form CMS-10175 EFI Certification Statement Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System	Form and Instruction
CMS-10175 EFI Certification Statement CMS-10175 - Certification Statement for Electronic File Interchange.pdf	Form and Instruction
CMS-10175 EFI Certification Statement CMS-10175 - Certification Statement for Electronic File Interchange.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

OHEI

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Form and Instruction	CMS-10175				Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

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
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	36	4	32
Annual IC Time Burden (Hours)	9	1	8
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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