Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106

ICR 200402-0938-013

OMB: 0938-0463

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0463 200402-0938-013
Historical Active 200103-0938-011
HHS/CMS
Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106
Extension without change of a currently approved collection   No
Regular
Approved without change 04/13/2004
Retrieve Notice of Action (NOA) 02/20/2004
  Inventory as of this Action Requested Previously Approved
04/30/2007 04/30/2007 05/31/2004
13,000 0 15,700
2,480,000 0 2,943,354
0 0 0

Form CMS-2540-96 is the form used by SNFs participating in the Medicare program. This form reports the health care costs to determine the amount of reimbursable costs for services rendered to Medicare beneficiaries.

None
None


No

1
IC Title Form No. Form Name
Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106 CMS-2540-96

  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 13,000 15,700 0 0 -2,700 0
Annual Time Burden (Hours) 2,480,000 2,943,354 0 0 -463,354 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.
02/20/2004


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