CERTIFICATE OF NEED FOR HEALTH FACILITY AND ASSURANCE OF ENFORCEMENT OF STATE STANDARDS

ICR 199110-2502-001

OMB: 2502-0210

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
2502-0210 199110-2502-001
Historical Active 198906-2502-014
HUD/OH
CERTIFICATE OF NEED FOR HEALTH FACILITY AND ASSURANCE OF ENFORCEMENT OF STATE STANDARDS
Extension without change of a currently approved collection   No
Regular
Approved without change 12/03/1991
Retrieve Notice of Action (NOA) 10/02/1991
  Inventory as of this Action Requested Previously Approved
11/30/1994 11/30/1994 11/30/1991
120 0 120
3,044 0 3,020
0 0 0

EVERY APPLICATION FOR INSURANCE OF A NURSING HOME, INTERMEDIATE CARE FACILITY OR HOSPITAL MUST HAVE EITHER A CERTIFICATE OF NEED (FORM HUD 2576-HF) ISSUED BY THE STATE AGENCY WITH JURISDICTION OR AN ACCEPTABLE ALTERNATIVE STUDY.

None
None


No

1
IC Title Form No. Form Name
CERTIFICATE OF NEED FOR HEALTH FACILITY AND ASSURANCE OF ENFORCEMENT OF STATE STANDARDS HUD 2576-HF

  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 120 120 0 0 0 0
Annual Time Burden (Hours) 3,044 3,020 0 24 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.
10/02/1991


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