Information Collection

Contractors Information Collections - Data From End Stage Renal Disease Facilities

IC 113187 under ICR 198301-0938-011 · OMB 0938-0230.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0230 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	CONTRACTORS INFORMATION COLLECTIONS - DATA FROM END STAGE RENAL DISEASE FACILITIES	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-9038				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,111	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	756,300	300	756,000
Annual IC Time Burden (Hours)	196,000	7,000	189,000
Annual IC Cost Burden (Dollars)	0	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.