Intermediate Care Facility for the Mentally Retarded or Persons with Related Conditions ICF/MR Survey Report Form (3070G-I)

Intermediate Care Facility for the Mentally Retarded or Persons with Related Conditions ICF/MR Survey Report Form (3070G-I) and Supporting Regulations at 42CFR 442.30, 483.410, 483.420,...

OMB: 0938-0062

IC ID: 7818

Information Collection (IC) Details

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Intermediate Care Facility for the Mentally Retarded or Persons with Related Conditions ICF/MR Survey Report Form (3070G-I)
 
Yes Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 431.52 42 CFR 431.151 42 CFR 483.400-480 42 CFR 442.40 42 CFR 488.332 42 CFR 488.400 42 CFR 442.42 42 CFR 442.100-119 42 CFR 498.3-5 42 CFR 435.1009 42 CFR 440.150 42 CFR 440.220 42 CFR 442.1 42 CFR 442.10-16 42 CFR 442.30

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-3070G ICF for Persons with Mental Retardation Survey Report CMS-3070G-I Forms.tif No No Paper Only

Health Consumer Health and Safety

 

6,428 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  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 19,284 0 -177,252,531 0 0 177,271,815
Annual IC Time Burden (Hours) 19,284 0 -6,822,254 0 0 6,841,538
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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