Information Collection

Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Sections 412.230, 412.304 and 413.65

IC 8746 under ICR 200309-0938-003 · OMB 0938-0907.

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Information Collection (IC) Details

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IC Title:	Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Sections 412.230, 412.304 and 413.65	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-10079				Yes	Yes

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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	720,000	720,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.