Information Collection

Minimum Data Set for Swing Bed Hospitals and Supporting Regulations in 42 0FR 413.114(a)(2) and 413.343(a) (CMS-10064)

IC 186455 under ICR 200809-0938-009 · OMB 0938-0872.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10064 MINIMUM DATA SET (MDS) For Swing Bed Hospitals Minimum Data Set for Swing Bed Hospitals and Supporting Regulations in 42 0FR 413.114(a)(2) and 413.343(a) (CMS-10064)	Form
sbmanual112005-RUG53.pdf	Other-Manual
CMS-10064 MINIMUM DATA SET (MDS) For Swing Bed Hospitals snfpps_swmds.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 413.114(a)(2) 42 CFR 413.343(a)

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
Form	CMS-10064				Yes	Yes	Paper Only
Other-Manual					Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 143

Number of Respondents for Small Entity: 128

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	15,015	15,015
Annual IC Time Burden (Hours)	97,598	97,598
Annual IC Cost Burden (Dollars)	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.

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