Information Collection

The Medicare/Medicaid Psychiatric Hospital Survey Data Contained in 42 CFR and Supporting Regulations in 42 CFR 482.60, 482.61, and 482.62

IC 8018 under ICR 200709-0938-006 · OMB 0938-0378.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0378 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-724 The Medicare/Medicaid Psychiatric Hospital Survey Data Contained in 42 CFR and Supporting Regulations in 42 CFR 482.60, 482.61, and 482.62 Form and Instruction
CMS-724 Mediare/Medicaid Psychiatric Hospital Survey Data CMS-724 Medicare - Medicaid Psychiatric Hospital Survey Data.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	The Medicare/Medicaid Psychiatric Hospital Survey Data Contained in 42 CFR and Supporting Regulations in 42 CFR 482.60, 482.61, and 482.62	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 482.60-482.62

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-724	Mediare/Medicaid Psychiatric Hospital Survey Data	CMS-724 Medicare - Medicaid Psychiatric Hospital Survey Data.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	100	100
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.