Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
42 CFR 411.362(b)(3)(ii)(A) and 489.20(u)(2) - Medical Staff by-Laws and Policies (Attorney) Removed 0 0 0
42 CFR 411.362(b)(3)(ii)(C) Updating disclosure notice on hospital's public website Modified 210 210 0
42 CFR 411.362(b)(5)(i) - Disclosures Removed 0 0 0
42 CFR 489.20(u)(1) Privide Physician List to Patients Modified 107 47 0
42 CFR 489.20(u)(1) - Attestation of non-Referring Status (Attorney) Removed 0 0 0
42 CFR 489.20(u)(1) - Develop Disclosure Modified 5 20 0
42 CFR 489.20(u)(1) - Outpatient Disclosure Removed 0 0 0
42 CFR 489.20(u)(1) - Providet Disclosure Form Modified 11158 930 0
42 CFR 489.20(w)(1)- (5)- Disclosure of Physician Owners/Investors to Staff Physicians Removed 0 0 0
42 CFR 489.20(w)(2) Distribution of Written Notice of Lack of Physician Coverage in Hospital New 2331817 38864 0
42 CFR 489.20(w)(4) Receive patient signature on written notice of lack of MD coverage New 2331817 38864 0
Total burden requested under this ICR: 4675114 78935 0  
To view an IC, click on IC Title