ESRD FACILITY SURVEY

ICR 198708-0938-017

OMB: 0938-0447

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
166298 Migrated
ICR Details
0938-0447 198708-0938-017
Historical Active 198608-0938-020
HHS/CMS
ESRD FACILITY SURVEY
No material or nonsubstantive change to a currently approved collection   No
Emergency 08/12/1987
Approved with change 08/12/1987
Retrieve Notice of Action (NOA) 08/12/1987
  Inventory as of this Action Requested Previously Approved
10/31/1988 10/31/1988 10/31/1988
1,368 0 1,368
2,790 0 2,394
0 0 0

MEDICARE PROGRAM. HEALTH SURVEYS. THE HCFA-2744 IS COMPLETED ANNUALL BY ALL MEDICARE-APPROVED ESRD FACILITIES. THE FORM WAS DESIGNED TO COLLECT INFORMATION CONCERNING TREATMENT TRENDS, UTILIZATION OF SERVIC AND PATTERNS OF PRACTICE IN TREATING ESRD PATIENTS.

None
None


No

1
IC Title Form No. Form Name
ESRD FACILITY SURVEY HCFA-2744

  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 1,368 1,368 0 0 0 0
Annual Time Burden (Hours) 2,790 2,394 0 396 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
08/12/1987


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