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 1597 532 0
Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare Program Modified 290 145 0 Form and Instruction CMS-29
Medical Secretary to complete mailing for all RHCs surveyed Modified 1597 266 900
Medical Secretary to compulete survey task -RHCs being surveyed Modified 1597 133 0
New RHCs review the statutory and regulatory law Modified 290 121 0
Photocopying of CMS-29 and filing by a Medical Secretary Modified 290 24 0
Preparation for and mailing of the CMS-29 Form to the State agencies Modified 290 48 0
Total burden requested under this ICR: 5951 1269 900  
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