Information Collection

484.65(e) - quality assessment and performance

IC 217403 under ICR 201701-0938-006 · OMB 0938-1299.

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Information Collection (IC) Details

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IC Title:	484.65(e) - quality assessment and performance	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 484.65(e)

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: 7,630	Number of Respondents for Small Entity: 7,630

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,630	7,630
Annual IC Time Burden (Hours)	30,520	30,520
Annual IC Cost Burden (Dollars)	0	0

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