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

Documents and forms in this information collection
Document NameDocument 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)

layout table

Information Collection Instruments:
table that charts list of instruments
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

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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

Documents for IC
table that charts IC Documents
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.