Medicare/Medicaid Phsychiatric Hospital Survey Data

ICR 199702-0938-009

OMB: 0938-0378

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
166277 Migrated
ICR Details
0938-0378 199702-0938-009
Historical Active 199508-0938-003
HHS/CMS
Medicare/Medicaid Phsychiatric Hospital Survey Data
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved with change 02/28/1997
Retrieve Notice of Action (NOA) 02/28/1997
  Inventory as of this Action Requested Previously Approved
08/31/1998 08/31/1998 08/31/1998
350 0 1
175 0 175
0 0 0

The collection of this data will assure an accurate data base for program planning and evaluation, and survey team composition for surveys of phsychiatric hospitals. All free standing psychiatric hospitals survyed will be required to respond.

None
None


No

1
IC Title Form No. Form Name
Medicare/Medicaid Phsychiatric Hospital Survey Data HCFA-724

  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 350 1 0 349 0 0
Annual Time Burden (Hours) 175 175 0 0 0 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.
02/28/1997


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