STATE SURVEY AGENCY BUDGET REQUEST - LONG-TERM CARE FACILITY WORKLOAD

ICR 199001-0938-002

OMB: 0938-0563

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0563 199001-0938-002
Historical Active
HHS/CMS
STATE SURVEY AGENCY BUDGET REQUEST - LONG-TERM CARE FACILITY WORKLOAD
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 02/23/1990
Retrieve Notice of Action (NOA) 01/25/1990
  Inventory as of this Action Requested Previously Approved
02/28/1993 02/28/1993
53 0 0
8,480 0 0
0 0 0

THIS FORM IS REQUIRED FOR STATE SURVEY AGENCIES TO REPORT WITH REGARD TO ANNUAL BUDGETARY PROJECTIONS WHICH SERVES AS A BASIS FOR BUDGET NEGOTIATIONS WITH FEDERAL OFFICIALS AND SUBSEQUENT FUNDS APPROVAL.

None
None


No

1
IC Title Form No. Form Name
STATE SURVEY AGENCY BUDGET REQUEST - LONG-TERM CARE FACILITY WORKLOAD HCFA-2815

  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 53 0 0 53 0 0
Annual Time Burden (Hours) 8,480 0 0 8,480 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.
01/25/1990


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