Information Collection

General Intermediate Care Facility Survey And Intermediate Care Fac. For The Mentally Retarded Or Persons With Related Conditions Surveys

IC 112713 under ICR 198301-0938-007 · OMB 0938-0062.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0062 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	GENERAL INTERMEDIATE CARE FACILITY SURVEY AND INTERMEDIATE CARE FAC. FOR THE MENTALLY RETARDED OR PERSONS WITH RELATED CONDITIONS SURVEYS	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.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-1516,	No	No
Form	HCFA-R17, &	No	No
Form	R18	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	54,000	54,000
Annual IC Cost Burden (Dollars)	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.