MEDICARE REIMBURSEMENT SETTLEMENT DATA FOR HOSPITALS AND SKILLED NURSING FACILITIES

ICR 198405-0938-003

OMB: 0938-0159

Federal Form Document

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Document
Name
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IC Document Collections
ICR Details
0938-0159 198405-0938-003
Historical Active 198306-0938-006
HHS/CMS
MEDICARE REIMBURSEMENT SETTLEMENT DATA FOR HOSPITALS AND SKILLED NURSING FACILITIES
Extension without change of a currently approved collection   No
Regular
Approved without change 06/04/1984
Retrieve Notice of Action (NOA) 05/03/1984
  Inventory as of this Action Requested Previously Approved
12/31/1984 12/31/1984 06/30/1984
291 0 291
3,783 0 3,783
0 0 0

THIS FORM IS USED BY THE OFFICE OF DIRECT REIMBURSEMENT (ODR) FOR COST SETTLEMENT WITH HOSPITALS AND SKILLED NURSING FACILITIES. IT INDICATE WHICH SERVICES HAVE BEEN PAID BY ODR AND WHICH ARE STILL OUTSTANDING AT THE TIME OF FINAL SETTLEMENT OF THE COST REPORT.

None
None


No

1
IC Title Form No. Form Name
MEDICARE REIMBURSEMENT SETTLEMENT DATA FOR HOSPITALS AND SKILLED NURSING FACILITIES HCFA-247

  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 291 291 0 0 0 0
Annual Time Burden (Hours) 3,783 3,783 0 0 0 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.
05/03/1984


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