Information Collection

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

IC 8128 under ICR 199711-0938-003 · OMB 0938-0511.

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IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-2540S				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,441

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,441	0	1,441
Annual IC Time Burden (Hours)	139,410	-3,249	142,659
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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