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

Documents and Forms

Document Name Document Type
Form CMS-684 A End-Stage Renal Disease (ESRD) Network Business Proposal Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112 Form
FINALJ-7instructions_060208.doc Instruction
CMS-684 A ESRD Network Business Proposal Forms FINALESRDBPformsJ-7a_01262005(2).xls Form
CMS-684 A-I Annual Management Plan FINALj-7bmanagementplan.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	End-Stage Renal Disease (ESRD) Network Business Proposal Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 405.2110 42 CFR 405.2112

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	1,080	1,080
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.