Information Collection

Information Collection Requirements In 405.1121, 405.1124, 405.1136, & 405.1137-conditions For Participation For Snfs 405.1122, 405.1123, 405.1125, 405, 1126, 405.1127, 405.1128

IC 113548 under ICR 198406-0938-016 · OMB 0938-0364.

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENTS IN 405.1121, 405.1124, 405.1136, & 405.1137-CONDITIONS FOR PARTICIPATION FOR SNFS 405.1122, 405.1123, 405.1125, 405, 1126, 405.1127, 405.1128	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-R-46				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,356	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
Annual Number of Responses for this IC	8,356	8,356
Annual IC Time Burden (Hours)	155,279	155,279
Annual IC Cost Burden (Dollars)	0	0

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