Information Collection

Home Office Cost Statement and Supporting Statement in Regulation in 42 CFR 413.17 and 413.20

IC 7879 under ICR 199903-0938-001 · OMB 0938-0202.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0202 can be found here:

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Information Collection (IC) Details

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IC Title:	Home Office Cost Statement and Supporting Statement in Regulation in 42 CFR 413.17 and 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-287				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,231	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,231	1,231
Annual IC Time Burden (Hours)	573,646	573,646
Annual IC Cost Burden (Dollars)	0	0

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Title	Document	Date Uploaded

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