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
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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