Information Collection

Informtion Collection Requirements In Berc-329-p, Payment Adjustment For Sole Community Hospital, 42 Cfr-412.92(b) Nprm

IC 113823 under ICR 198605-0938-005 · OMB 0938-0477.

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Information Collection (IC) Details

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IC Title:	INFORMTION COLLECTION REQUIREMENTS IN BERC-329-P, PAYMENT ADJUSTMENT FOR SOLE COMMUNITY HOSPITAL, 42 CFR-412.92(B) NPRM	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-79				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
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.