Information Collection

Fire Safety Survey Report Forms and Supporting Regulations in 42 CFR 416.44, 418.100, 482.41, 483.70, and 483.470

IC 7897 under ICR 200307-0938-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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, 483.70, 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-W	No	No
Form	CMS-2786-M	No	No
Form	2786-Y	No	No
Form	2786-T	No	No
Form	2786-X	No	No
Form	2786-R	No	No
Form	2786-U	No	No
Form	2786-V	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27,900	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	27,900	0	27,900
Annual IC Time Burden (Hours)	2,325	-22,675	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.