Information Collection

Fire Safety Survey Report Forms and Supporting Regulations in 42 CFR 416.44, 418.100, 482.41, 483.270, and 483.470

IC 7895 under ICR 199904-0938-001 · OMB 0938-0242.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0242 can be found here:

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Information Collection (IC) Details

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IC Title:	Fire Safety Survey Report Forms and Supporting Regulations in 42 CFR 416.44, 418.100, 482.41, 483.270, and 483.470	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.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-2786(A-D)	No	No
Form	2786(F-H)	No	No
Form	2786(Q)	No	No
Form	2786(J-M)	No	No
Form	2786(P)	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,000	6,776	23,224
Annual IC Time Burden (Hours)	25,000	4,463	20,537
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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