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Paperwork Burden Associated With The Hospital Survey And Request To Establish Eligibility

IC 112901 under ICR 198212-0938-007 · OMB 0938-0103.

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PAPERWORK BURDEN ASSOCIATED WITH THE HOSPITAL SURVEY AND REQUEST TO ESTABLISH ELIGIBILITY
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-R11 No No
Form HCFA-1514 No No


    

1,026 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Requested 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 1,026 0 0 0 0 1,026
Annual IC Time Burden (Hours) 23,598 0 0 0 0 23,598
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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