End-Stage Renal Disease (ESRD) Network Business Proposal Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112

ICR 200308-0938-002

OMB: 0938-0658

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0658 200308-0938-002
Historical Active 200010-0938-002
HHS/CMS
End-Stage Renal Disease (ESRD) Network Business Proposal Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112
Extension without change of a currently approved collection   No
Regular
Approved without change 09/09/2003
Retrieve Notice of Action (NOA) 08/05/2003
  Inventory as of this Action Requested Previously Approved
09/30/2006 09/30/2006 12/31/2003
36 0 36
1,080 0 1,080
0 0 0

The submission of business proposal information by current ESRD networks and other bidders, according to the business proposal instructions, meets CMS need for meaningful, consistent, and verifiable data when evaluating contract proposals.

None
None


No

1
IC Title Form No. Form Name
End-Stage Renal Disease (ESRD) Network Business Proposal Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112 CMS-684A-684I

  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 36 36 0 0 0 0
Annual Time Burden (Hours) 1,080 1,080 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.
08/05/2003


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