Skilled Nursing Facility Prospective Payment System Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

ICR 199711-0938-003

OMB: 0938-0511

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0511 199711-0938-003
Historical Active 199410-0938-003
HHS/CMS
Skilled Nursing Facility Prospective Payment System Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24
Revision of a currently approved collection   No
Regular
Approved without change 01/09/1998
Retrieve Notice of Action (NOA) 11/12/1997
  Inventory as of this Action Requested Previously Approved
01/31/2001 01/31/2001 01/31/1998
1,441 0 1,441
139,410 0 142,659
0 0 0

The Skilled Nursing Facility Prospective Payment System Cost Report is the cost report to be used by free-standing SNFs to achieve a settlement of costs for health care services rendered to Medicare beneficiaries.

None
None


No

1
IC Title Form No. Form Name
Skilled Nursing Facility Prospective Payment System Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24 HCFA-2540S

  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 1,441 1,441 0 0 0 0
Annual Time Burden (Hours) 139,410 142,659 0 -3,249 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
11/12/1997


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