Information Collection

Independent Rural Health Center/Freestanding Federally Qualified Health Center Cost Report and Supp. Regs in 42 CFR Sections 413.20 and 413.24 (CMS-222)

IC 7853 under ICR 200803-0938-007 · OMB 0938-0107.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0107 can be found here:

Documents and Forms

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Independent Rural Health Center/Freestanding Federally Qualified Health Center Cost Report and Supp. Regs in 42 CFR Sections 413.20 and 413.24 (CMS-222)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 413.20 42 CFR 413.24

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Form CMS-222-92	CMS-222 forms-t7.xls	Yes	Yes	Paper Only
Instruction	CMS-222 pr2_29_toc.doc	Yes	Yes	Paper Only
Instruction	CMS-222 pr2_2900_to_2910.doc	Yes	Yes	Paper Only
Instruction	CMS-222 pr2_2990.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,159	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: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,159	159	3,000
Annual IC Time Burden (Hours)	157,950	7,950	150,000
Annual IC Cost Burden (Dollars)	0	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.