Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Financial Review Modified 50 450 0 Form and Instruction CMS-10328 Medicare Self-Referral Disclosure Protocol
Legal Review Modified 50 750 0 Form and Instruction CMS-10328 Medicare Self-Referral Disclosure Protocol
Total burden requested under this ICR: 100 1200 0  
To view an IC, click on IC Title