Information Collection

Hospitals and Health Care Complex Cost Report (CMS-2552-96)

IC 7814 under ICR 200802-0938-004 · OMB 0938-0050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
P152_36Inst.zip	Instruction
R17P236f.zip	Other-CMS-2552-96
CMS-2552-96 Revisions - Crosswalk from old to new.doc CMS-2552-96 Revisions - Crosswalk from old to new	IC Document
R17P236s.zip R17P236s	IC Document

IC Title:

Hospitals and Health Care Complex Cost Report (CMS-2552-96)

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			P152_36Inst.zip		No	No	Paper Only
Other-CMS-2552-96			R17P236f.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,175

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,175	64	6,111
Annual IC Time Burden (Hours)	4,090,474	43,692	4,046,782
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-2552-96 Revisions - Crosswalk from old to new	CMS-2552-96 Revisions - Crosswalk from old to new.doc	02/15/2008
R17P236s	R17P236s.zip	02/15/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.