Information Collection

End Stage Renal Disease Death Notification P. L. 95-292; 42CFR405.2133; CFR401,422E

IC 8066 under ICR 200301-0938-003 · OMB 0938-0448.

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Information Collection (IC) Details

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IC Title:	End Stage Renal Disease Death Notification P. L. 95-292; 42CFR405.2133; CFR401,422E	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	CMS-2746				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	63,000	6,742	56,258
Annual IC Time Burden (Hours)	10,710	1,146	9,564
Annual IC Cost Burden (Dollars)	0	0	0

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