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End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations 42 CFR 488.60
End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations 42 CFR 488.60
OMB: 0938-0360
IC ID: 8003
OMB.report
HHS/CMS
OMB 0938-0360
ICR 200311-0938-003
IC 8003
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0360 can be found here:
2022-05-04 - Reinstatement with change of a previously approved collection
2020-02-12 - Reinstatement with change of a previously approved collection
Documents and Forms
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Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
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IC Title:
End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations 42 CFR 488.60
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.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-3427
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,000
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,320
0
0
645
0
675
Annual IC Time Burden (Hours)
440
0
0
-1,186
0
1,626
Annual IC Cost Burden (Dollars)
0
0
0
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.