AMBULATORY SURGICAL CENTER PAYMENT RATE SURVEY

ICR 199304-0938-005

OMB: 0938-0434

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
113711 Migrated
ICR Details
0938-0434 199304-0938-005
Historical Active 199106-0938-007
HHS/CMS
AMBULATORY SURGICAL CENTER PAYMENT RATE SURVEY
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 07/15/1993
Retrieve Notice of Action (NOA) 04/19/1993
  Inventory as of this Action Requested Previously Approved
07/31/1996 07/31/1996
250 0 0
8,000 0 0
0 0 0

AUTHORIZATION FOR THE AMBULATORY SURGICAL CENTER PAYMENT RATE SURVEY, HCFA-452, EXPIRED SEPTEMBER 30, 1992. HOWEVER, OUR DATA COLLECTION EFFORTS FOR RATE UPDATING AFTER 1992 ARE INCOMPLETE. THEREFORE, WE AR REQUESTING THAT PART II OF THIS TWO PART SURVEY INSTRUMENT BE REINSTAT TO GATHER NEW COST INFORMATION.

None
None


No

1
IC Title Form No. Form Name
AMBULATORY SURGICAL CENTER PAYMENT RATE SURVEY HCFA-452

  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 250 0 0 250 0 0
Annual Time Burden (Hours) 8,000 0 0 8,000 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.
04/19/1993


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