Information Collection

Renal Disease Facility Cost And Statistical Questionnaire

IC 166100 under ICR 197803-0938-016 · OMB 0938-0048.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0048 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	RENAL DISEASE FACILITY COST AND STATISTICAL QUESTIONNAIRE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA 9734				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	900	300	600
Annual IC Time Burden (Hours)	900	300	600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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