THE HCFA-2746 IS COMPLETED BY ALL
MEDICARE APPROVED ESRD FACILITIES UPON THE DEATH OF AN ESRD
PATIENT. IT'S PRIMARY PURPOSE IS TO COLLECT FACT OF DEATH AND CAUSE
OF DEATH. REPOR OF DEATHS ARE USED IN PREPARING THE ESRD PATIENT
PROFILE TABLES, WHICH SHOW DEMOGRAPHIC CHARACTERISTICS OF DEAD
PATIENTS ALONG WITH THE CAUSE OF DEATH.
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.