PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Completion of the Survey CMS-29 Form for state survey agency triennial survey
Modified
1414
236
0
Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare Program
Modified
210
70
0
Form and Instruction
CMS-29
Verification of Clinic Data - Rural Health Clinic Program
Medical Secretary to complete mailing for all RHCs surveyed
Modified
1414
236
812
Medical Secretary to compulete survey task -RHCs being surveyed
Modified
1414
118
0
New RHCs review the statutory and regulatory law
Modified
210
88
0
Photocopying of CMS-29 and filing by a Medical Secretary
Modified
210
18
0
Preparation for and mailing of the CMS-29 Form to the State agencies
Modified
210
35
0
Total burden requested under this ICR:
5082
801
812
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