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Medicare/Medicaid Phsychiatric Hospital Survey Data
Medicare/Medicaid Phsychiatric Hospital Survey Data
OMB: 0938-0378
IC ID: 166277
OMB.report
HHS/CMS
OMB 0938-0378
ICR 199702-0938-009
IC 166277
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0378 can be found here:
2021-04-14 - Reinstatement without change of a previously approved collection
2017-07-21 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medicare/Medicaid Phsychiatric Hospital Survey Data
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.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HCFA-724
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
350
Number of Respondents for Small Entity:
0
Affected Public:
Federal Government
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
350
0
349
0
0
1
Annual IC Time Burden (Hours)
175
0
0
0
0
175
Annual IC Cost Burden (Dollars)
0
0
0
0
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.