Medicare Physician Fee Schedule Geographic Practice Expense Index (GPCI)

Documents and Forms

Document Name Document Type
Form CMS-R-143 Medicare Physician Fee Schedule Geographic Practice Expense Index (GPCI) Form and Instruction
CMS-R-143 CMS-R-143 Survey R-143survey.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare Physician Fee Schedule Geographic Practice Expense Index (GPCI)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-143	CMS-R-143 Survey	R-143survey.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.