View Information Collection (IC)

View Information Collection (IC)

Pressure Ulcer Submissions
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10409 LTCH Care Data Set Admissions LTCH CARE Data Set_Admission_v2 00_20121120.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 LTCH Care Data Set Expired LTCH CARE Data Set_Expired_v2 00.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 LTCH Care Data Set Planned Discharge LTCH CARE Data Set_Planned Discharge_v2 00_20121120.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 LTCH Care Data Set Unplanned Discharge LTCH CARE Data Set_Unplanned Discharge_v2 00_20121120.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

442 200
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 403,988 140,988 0 0 0 263,000
Annual IC Time Burden (Hours) 212,160 168,660 0 0 0 43,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix B - Change Table Appendix B Change Table for PRA_V2 00_20121207.docx 04/12/2013
Appendix A - LTCH Item Matrix Appendix A LTCH CARE Item Matrix_V2 00_20121207.xlsx 04/12/2013
Burden Calculations LTCH clean 12 19 12 Burden Calculations LTCH clean 12 19 12.docx 04/12/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.