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Renal Dialysis Facility Cost Report
 
No Modified
 
Mandatory
 
42 CFR 413.20 42 CFR 413.24 42 CFR 413.178

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Yes No Printable Only
Form CMS-265-11 Yes Yes Fillable Fileable Signable

Health Health Care Services

 

6,821 0
   
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 6,821 0 0 1,144 0 5,677
Annual IC Time Burden (Hours) 443,365 0 0 74,360 0 369,005
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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