Independent Renal Dialysis Facility Cost Report and Supporting Regulations 42 CFR 413.198 and 42 CFR 413.20

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Information Collection (IC) Details

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IC Title:	Independent Renal Dialysis Facility Cost Report and Supporting Regulations 42 CFR 413.198 and 42 CFR 413.20	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-265				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,472	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,472	790	1,682
Annual IC Time Burden (Hours)	484,512	154,840	329,672
Annual IC Cost Burden (Dollars)	0	0	0

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