View Information Collection (IC)

View Information Collection (IC)

Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106
 
No Modified
 
Mandatory
 
42 CFR 413.24 42 CFR 413.20

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction pr2_41_toc.doc Yes No Printable Only
Instruction pr2_4108_to_4120.doc Yes No Printable Only
Instruction pr2_4121_to_4130.2.doc Yes No Printable Only
Instruction pr2_4131_to_4161.doc Yes No Printable Only
Instruction pr2_4190.doc Yes No Printable Only
Instruction pr2_4195.doc Yes No Printable Only
Form CMS-2540-10 Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report Certification and Settlement Summary CMS-2540-10 FORMS.xls Yes Yes Fillable Fileable
Instruction pr2_4100_to_4107 [rev 07-13-11].doc Yes No Printable Only

Health Health Care Services

 

15,701 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 15,701 0 0 664 0 15,037
Annual IC Time Burden (Hours) 3,171,602 94,206 251,216 119,520 0 2,706,660
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-2540-10 Crosswalk [Added Worksheet] CMS-2540 Crosswalk.xlsx 07/13/2011
Instruction, Section 4195 - Crosswalk pr2_4195 Crosswalk.doc 07/14/2011
Instructiom, Section 4105 - Crosswalk pr2_4100_to_4107 Crosswalk.doc 07/14/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.