Hospitals and Health Care Complex Cost Report

ICR 200502-0938-012

OMB: 0938-0050

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
7814 Migrated
ICR Details
0938-0050 200502-0938-012
Historical Active 200208-0938-012
HHS/CMS
Hospitals and Health Care Complex Cost Report
Revision of a currently approved collection   No
Regular
Approved with change 05/06/2005
Retrieve Notice of Action (NOA) 02/25/2005
  Inventory as of this Action Requested Previously Approved
05/31/2008 05/31/2008 11/30/2005
6,111 0 6,010
4,046,782 0 3,980,522
0 0 0

Form 2552-96 is the form used by hospitals 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
Hospitals and Health Care Complex Cost Report 2552-96

  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 6,111 6,010 0 101 0 0
Annual Time Burden (Hours) 4,046,782 3,980,522 0 66,260 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
02/25/2005


© 2024 OMB.report | Privacy Policy