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Medicare/Medicaid Hospital Survey Report Form Supporting Regulations in 42 CFR 482.2 through 482.57
Medicare/Medicaid Hospital Survey Report Form Supporting Regulations in 42 CFR 482.2 through 482.57
OMB: 0938-0382
IC ID: 8026
OMB.report
HHS/CMS
OMB 0938-0382
ICR 199912-0938-003
IC 8026
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0382 can be found here:
2003-09-05 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medicare/Medicaid Hospital Survey Report Form Supporting Regulations in 42 CFR 482.2 through 482.57
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.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HCFA-1537
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,123
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,123
0
0
-199
0
1,322
Annual IC Time Burden (Hours)
3,650
0
0
-646
0
4,296
Annual IC Cost Burden (Dollars)
0
0
0
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.