Information Collection

Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106

IC 8084 under ICR 200703-0938-008 · OMB 0938-0463.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0463 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-2540 pr2_35_toc.doc	Other-Section Outline
CMS-2540 pr2_3500_to_3512.doc	Instruction
CMS-2540 pr2_3500_to_3512revised.doc	Instruction
CMS-2540 pr2_3513_to_3524.1_(cont).doc	Instruction
CMS-2540 pr2_3525_to_3534.4.doc	Instruction
CMS-2540 pr2_3535_to_3553.2.doc	Instruction
CMS-2540 pr2_3553.2_(cont)_to_3564.4.doc	Instruction
CMS-2540 pr2_3565_to_3571_(cont).doc	Instruction
CMS-2540 pr2_3595.doc	Instruction
CMS-2540-96 Cost Reports CMS-2540 R132540f (version 2).xls	Form

IC Title:

Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.20 42 CFR 413.24

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Section Outline			CMS-2540 pr2_35_toc.doc	Yes	Yes	Paper Only
Instruction			CMS-2540 pr2_3500_to_3512.doc	Yes	Yes	Paper Only
Instruction			CMS-2540 pr2_3500_to_3512revised.doc	Yes	Yes	Paper Only
Instruction			CMS-2540 pr2_3513_to_3524.1_(cont).doc	Yes	Yes	Paper Only
Instruction			CMS-2540 pr2_3525_to_3534.4.doc	Yes	Yes	Paper Only
Instruction			CMS-2540 pr2_3535_to_3553.2.doc	Yes	Yes	Paper Only
Instruction			CMS-2540 pr2_3553.2_(cont)_to_3564.4.doc	Yes	Yes	Paper Only
Instruction			CMS-2540 pr2_3565_to_3571_(cont).doc	Yes	Yes	Paper Only
Instruction			CMS-2540 pr2_3595.doc	Yes	Yes	Paper Only
Form	CMS-2540-96	Cost Reports	CMS-2540 R132540f (version 2).xls	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,037

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15,037	2,037	13,000
Annual IC Time Burden (Hours)	2,947,252	467,252	2,480,000
Annual IC Cost Burden (Dollars)	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.