MEDICARE: ESRD FACILITY SURVEY

ICR 199303-0938-008

OMB: 0938-0447

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
113752 Migrated
ICR Details
0938-0447 199303-0938-008
Historical Active 199008-0938-002
HHS/CMS
MEDICARE: ESRD FACILITY SURVEY
Revision of a currently approved collection   No
Regular
Approved without change 05/20/1993
Retrieve Notice of Action (NOA) 03/24/1993
This submission, including agency amendments dated 5/19/93, is approved for use through 5/96.
  Inventory as of this Action Requested Previously Approved
05/31/1996 05/31/1996 10/31/1993
2,400 0 1,950
3,600 0 2,925
0 0 0

THIS FORM IS COMPLETED ANNUALLY BY ALL MEDICARE-APPROVED ESRD FACILITIES. THE FORM IS DESIGNED TO COLLECT INFORMATION CONCERNING TREATMENT TRENDS, UTILIZATION OF SERVICES, AND PATTERNS OF PRACTICE IN TREATING ESRD PATIENTS.

None
None


No

1
IC Title Form No. Form Name
MEDICARE: ESRD FACILITY SURVEY HCFA-2744

  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 2,400 1,950 0 0 450 0
Annual Time Burden (Hours) 3,600 2,925 0 0 675 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.
03/24/1993


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