View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 413.20
42 CFR 413.24
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Section Outline
CMS-2540 pr2_35_toc.doc
Yes
Yes
Paper Only
Instruction
CMS-2540 pr2_3500_to_3512.doc
Yes
Yes
Paper Only
Instruction
CMS-2540 pr2_3500_to_3512revised.doc
Yes
Yes
Paper Only
Instruction
CMS-2540 pr2_3513_to_3524.1_(cont).doc
Yes
Yes
Paper Only
Instruction
CMS-2540 pr2_3525_to_3534.4.doc
Yes
Yes
Paper Only
Instruction
CMS-2540 pr2_3535_to_3553.2.doc
Yes
Yes
Paper Only
Instruction
CMS-2540 pr2_3553.2_(cont)_to_3564.4.doc
Yes
Yes
Paper Only
Instruction
CMS-2540 pr2_3565_to_3571_(cont).doc
Yes
Yes
Paper Only
Instruction
CMS-2540 pr2_3595.doc
Yes
Yes
Paper Only
Form
CMS-2540-96
Cost Reports
CMS-2540 R132540f (version 2).xls
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
15,037
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
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
15,037
0
0
2,037
0
13,000
Annual IC Time Burden (Hours)
2,947,252
0
0
467,252
0
2,480,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.