OMB
.report
Search
Medicare/medicaid -- Skilled Nursing Facilities And Nursing Facilities Survey Report Form And Worksheets
MEDICARE/MEDICAID -- SKILLED NURSING FACILITIES AND NURSING FACILITIES SURVEY REPORT FORM AND WORKSHEETS
OMB: 0938-0400
IC ID: 113658
OMB.report
HHS/CMS
OMB 0938-0400
ICR 198907-0938-001
IC 113658
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MEDICARE/MEDICAID -- SKILLED NURSING FACILITIES AND NURSING FACILITIES SURVEY REPORT FORM AND WORKSHEETS
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-519
No
No
Form
HCFA-525
No
No
Form
THRU
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
31,414
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
31,414
0
0
0
0
31,414
Annual IC Time Burden (Hours)
125,675
0
0
0
0
125,675
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.