SUMMARY OF DEFICIENCIES NOT CORRECTED

ICR 198103-0938-008

OMB: 0938-0053

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
112670 Migrated
ICR Details
0938-0053 198103-0938-008
Historical Active 197803-0938-008
HHS/CMS
SUMMARY OF DEFICIENCIES NOT CORRECTED
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 03/16/1981
Retrieve Notice of Action (NOA) 03/14/1981
  Inventory as of this Action Requested Previously Approved
04/30/1981 04/30/1981
7,100 0 0
7,100 0 0
0 0 0

THIS FORM LISTS DEFICIENCIES DISCOVERED DURING A MEDICARE/MEDICAID CERTIFICATION SURVEY WHICH HAVE NOT BEEN CORRECTED SINCE THE PRECEDING SURVEY.

None
None


No

1
IC Title Form No. Form Name
SUMMARY OF DEFICIENCIES NOT CORRECTED HCFA-2567E

  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 7,100 0 0 0 7,100 0
Annual Time Burden (Hours) 7,100 0 0 0 7,100 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
03/14/1981


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