Information Collection

End Stage Renal Disease (esrd) Network Business Proposal

IC 114122 under ICR 199407-0938-004 · OMB 0938-0658.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0658 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	END STAGE RENAL DISEASE (ESRD) NETWORK BUSINESS PROPOSAL	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-684	No	No
Form	684A, 684B	No	No
Form	684C, 684D	No	No
Form	684E, 684F	No	No
Form	684G, 684H	No	No
Form	684I, 684J	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	1,080	1,080
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.