OUTPATIENT PHYSICAL THERAPY OUTPATIENT SPEECH PATHOLOGY PROVIDER COST REPORTS

ICR 198102-0938-010

OMB: 0938-0037

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0037 198102-0938-010
Historical Active 198012-0938-006
HHS/CMS
OUTPATIENT PHYSICAL THERAPY OUTPATIENT SPEECH PATHOLOGY PROVIDER COST REPORTS
Revision of a currently approved collection   No
Regular
Approved without change 03/27/1981
Retrieve Notice of Action (NOA) 02/23/1981
  Inventory as of this Action Requested Previously Approved
03/31/1984 03/31/1984 03/31/1981
419 0 250
13,827 0 3,000
0 0 0

THE COST REPORT WILL ENSURE PROPER PAYMENTS BY THE FISCAL INTERMEDIARY TO THE PROVIDER FOR MEDICARE COVERED SERVICES. THE FISCAL INTERMEDIAR ALSO USES THE COST REPORT IN DECIDING WHETHER TO AUDIT THE RECORDS OF THE PROVIDER. IN ADDITION, THE FISCAL INTERMEDIARY EXTRACTS DATA FROM THE COST REPORT FOR TRANSMISSION TO HCFA USED FOR MAKING PROJECTIONS.

None
None


No

1
IC Title Form No. Form Name
OUTPATIENT PHYSICAL THERAPY OUTPATIENT SPEECH PATHOLOGY PROVIDER COST REPORTS HCFA-2088

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 419 250 0 87 82 0
Annual Time Burden (Hours) 13,827 3,000 0 5,577 5,250 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/23/1981


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