OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 8240 under ICR 200612-0938-008 · OMB 0938-0658.

Documents and Forms
Document Name
Document Type
Form
Instruction
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

End-Stage Renal Disease (ESRD) Network Business Proposal Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 405.2110 42 CFR 405.2112

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-684 A ESRD Network Business Proposal Forms FINALESRDBPformsJ-7a_01262005(2).xls Yes Yes Fillable Fileable
Form CMS-684 A-I Annual Management Plan FINALj-7bmanagementplan.xls Yes Yes Fillable Fileable
Instruction FINALJ-7instructions_060208.doc Yes No Printable Only

Health Health Care Services

 

18 0
   
Private Sector Not-for-profit institutions
 
   100 %

  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 36 0 0 0 0 36
Annual IC Time Burden (Hours) 1,080 0 0 0 0 1,080
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.