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Notice of Right to Good Faith Estimate – Wholly Physician-Owned Private Practices

IC 253132 under ICR 202303-0938-013 · OMB 0938-1433.

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Document Name
Document Type
Instruction
Instruction
Information Collection (IC) Details

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Notice of Right to Good Faith Estimate – Wholly Physician-Owned Private Practices CCIIO - 10791
 
No Unchanged
 
Mandatory
 
45 CFR 149.610

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction 11. Appendix-HHS Good Faith Estimate Data Elements_04.15.22_clean.pdf Yes Yes Paper Only

Health Health Care Services

 

120,525 0
   
Private Sector Not-for-profit institutions
 
   5 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 120,525 0 0 0 0 120,525
Annual IC Time Burden (Hours) 421,837 0 0 0 0 421,837
Annual IC Cost Burden (Dollars) 50,649,426 0 0 0 0 50,649,426

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