END-STAGE RENAL DISEASE DEMONSTRATION PROJECT-COST REPORT

ICR 198109-0938-005

OMB: 0938-0114

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
0938-0114 198109-0938-005
Historical Active 197806-0938-002
HHS/CMS
END-STAGE RENAL DISEASE DEMONSTRATION PROJECT-COST REPORT
Revision of a currently approved collection   No
Regular
Approved without change 11/05/1981
Retrieve Notice of Action (NOA) 09/25/1981
  Inventory as of this Action Requested Previously Approved
10/31/1984 10/31/1984 10/31/1981
24 0 56
3,000 0 3,763
0 0 0

THE COST REPORT, USED BY HCFA'S OFFICE OF DIRECT REIMBURSEMENT, ENSURE PROPER AND TIMELY PAYMENTS TO THE FACILITIES.

None
None


No

1
IC Title Form No. Form Name
END-STAGE RENAL DISEASE DEMONSTRATION PROJECT-COST REPORT THRU C, HCFA-9734A

  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 24 56 0 -32 0 0
Annual Time Burden (Hours) 3,000 3,763 0 -763 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
09/25/1981


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