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ESRD Network Business Proposal Forms
ESRD Network Business Proposal Forms
OMB: 0938-0658
IC ID: 8238
OMB.report
HHS/CMS
OMB 0938-0658
ICR 199709-0938-009
IC 8238
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0658 can be found here:
2006-12-22 - Extension without change of a currently approved collection
2003-08-05 - 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:
ESRD Network Business Proposal Forms
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-684-684J
No
No
Form
42CFR-405.2110
No
No
Form
405.2112
No
No
Federal Enterprise Architecture Business Reference Module
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 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
36
0
0
0
0
36
Annual IC Time Burden (Hours)
1,080
0
0
0
0
1,080
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.