Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
HOPDs/ASCs Patient Records Modified 3300 92400 0 Form and Instruction CMS-10500
Form CMS-10500
Form and Instruction CMS-10500
Mode Experiment Removed 0 0 0 Form CMS-10500
Form and Instruction CMS-10500
Form and Instruction CMS-10500
National Implementation Modified 990000 128700 0 Form CMS-10500
Form and Instruction CMS-10500
Form and Instruction CMS-10500
Total burden requested under this ICR: 993300 221100 0  
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