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 7896 under ICR 200205-0938-011 · OMB 0938-0242.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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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	2786-P	No	No
Form	2786-F	No	No
Form	2786-M	No	No
Form	2786-Q	No	No
Form	2786-J	No	No
Form	2786-G	No	No
Form	2786-L	No	No
Form	2786-H	No	No
Form	2786-K	No	No
Form	CMS-2786-A-D	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	27,900	-2,100	30,000
Annual IC Time Burden (Hours)	25,000	0	25,000
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.