Restraints/Seclusion Death Reporting for Hospitals and Supporting Regulations at 42 CFR 482.13

ICR 200101-0938-011

OMB: 0938-0824

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0824 200101-0938-011
Historical Active
HHS/CMS
Restraints/Seclusion Death Reporting for Hospitals and Supporting Regulations at 42 CFR 482.13
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/25/2001
Retrieve Notice of Action (NOA) 01/30/2001
  Inventory as of this Action Requested Previously Approved
05/31/2004 05/31/2004
75 0 0
3 0 0
0 0 0

The collection of this data is required by 432 CFR 482.13 and will be used by HCFA to supplement survey and monitoring efforts.

None
None


No

1
IC Title Form No. Form Name
Restraints/Seclusion Death Reporting for Hospitals and Supporting Regulations at 42 CFR 482.13 HCFA-10004

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 75 0 0 75 0 0
Annual Time Burden (Hours) 3 0 0 3 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/30/2001


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