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End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations 42 CFR 405.2100 - 405.2184
End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations 42 CFR 405.2100 - 405.2184
OMB: 0938-0360
IC ID: 8002
OMB.report
HHS/CMS
OMB 0938-0360
ICR 200009-0938-013
IC 8002
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0360 can be found here:
2022-05-04 - Reinstatement with change of a previously approved collection
2020-02-12 - Reinstatement with change of a previously approved collection
Documents and Forms
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Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
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IC Title:
End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations 42 CFR 405.2100 - 405.2184
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-3427
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,740
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
675
0
0
-381
0
1,056
Annual IC Time Burden (Hours)
1,626
0
0
-750
0
2,376
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.