SKILLED NURSING FACILITY PROSPECTIVE PAYMENT COST REPORT

ICR 199107-0938-005

OMB: 0938-0511

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
113899 Migrated
ICR Details
0938-0511 199107-0938-005
Historical Active 198707-0938-003
HHS/CMS
SKILLED NURSING FACILITY PROSPECTIVE PAYMENT COST REPORT
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 10/22/1991
Retrieve Notice of Action (NOA) 07/23/1991
  Inventory as of this Action Requested Previously Approved
10/31/1994 10/31/1994
1,441 0 0
142,659 0 0
0 0 0

MEDICARE, PROVIDER COST, SKILLED NURSING FACILITY, PROSPECTIVE PAYMEN THIS FORM IS TO BE USED BY SKILLED NURSING FACILITIES WITH LESS THAN 1,500 MEDICARE PATIENT DAYS, AT THEIR OPTION, TO REPORT COSTS INCURRED

None
None


No

1
IC Title Form No. Form Name
SKILLED NURSING FACILITY PROSPECTIVE PAYMENT COST REPORT HCFA-2540S, 87

  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 1,441 0 0 0 1,441 0
Annual Time Burden (Hours) 142,659 0 0 0 142,659 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
07/23/1991


© 2024 OMB.report | Privacy Policy