Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Financial Review Modified 100 1000 0 Form and Instruction CMS-10328 Medicare Self-Referral Disclosure Protocol
Legal Review Modified 100 4000 0 Form and Instruction CMS-10328 Medicare Self-Referral Disclosure Protocol
Total burden requested under this ICR: 200 5000 0  
To view an IC, click on IC Title