Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Financial Review	Modified	100	1500	0	Form and Instruction	CMS-10328	CMS-10328_Physician_Information_Form
					Form and Instruction	CMS-10328	Self Referral Disclosure
					Form and Instruction	CMS-10328	Group Practice
Legal Review	Modified	100	3500	0	Form and Instruction	CMS-10328	Self-Referral_Disclosure_Protocol_Form
					Form and Instruction	CMS-10328	Physician-Information
					Form and Instruction	CMS-10328	Group Practice Information
Total burden requested under this ICR:		200	5000	0
To view an IC, click on IC Title