Information Collection

Ambulatory Surgical Center Request for Certification and Survey Report and Supporting Regulations in 42 CFR 416.1-416.150

IC 7911 under ICR 199911-0938-009 · OMB 0938-0266.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0266 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Ambulatory Surgical Center Request for Certification and Survey Report and Supporting Regulations in 42 CFR 416.1-416.150	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-377	No	No
Form	HCFA-378	No	No
Form	HCFA-R-54	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,798	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	2,931	-869	3,800
Annual IC Time Burden (Hours)	1,434	9	1,425
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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