Independent Rural Health Center/Freestanding Federally Qualified Health Center Cost Report and Supporting Regulations in 42 CFR Sections 413.20 and 413.24

ICR 200208-0938-018

OMB: 0938-0107

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0107 200208-0938-018
Historical Active 199909-0938-007
HHS/CMS
Independent Rural Health Center/Freestanding Federally Qualified Health Center Cost Report and Supporting Regulations in 42 CFR Sections 413.20 and 413.24
Extension without change of a currently approved collection   No
Regular
Approved without change 10/31/2002
Retrieve Notice of Action (NOA) 08/29/2002
  Inventory as of this Action Requested Previously Approved
10/31/2005 10/31/2005 11/30/2002
3,000 0 3,000
150,000 0 150,000
0 0 0

The Independent Rural Health Clinic/Freestanding Federally Qualified Health Center Cost Report is the cost report to be used by the mentioned clinics/centers to submit annual information to achieve a settlement of costs for health care services rendered to medicare beneficiaries.

None
None


No

  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 3,000 3,000 0 0 0 0
Annual Time Burden (Hours) 150,000 150,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
08/29/2002


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