OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

MPAF Data and Supporting Regulations in 42 CFR Sections 413.337, 413.343, 424.32 and 483.20

IC 188651 under ICR 200904-0938-002 · OMB 0938-0739.

Documents and Forms
Document Name
Document Type
Form
Other-Form page 2
Other-Form page 3
Other-Form page 4
Other-Form page 5
Form
Information Collection (IC) Details

View Information Collection (IC)

MPAF Data and Supporting Regulations in 42 CFR Sections 413.337, 413.343, 424.32 and 483.20
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 413.337 42 CFR 413.343 42 CFR 424.32 42 CFR 483.20

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-R-250 MDS Medicare PPS Assessment Form MDS20MDSAllForms 31.pdf Yes Yes Paper Only
Other-Form page 2 MDS20MDSAllForms 32.pdf Yes Yes Paper Only
Other-Form page 3 MDS20MDSAllForms 33.pdf Yes Yes Paper Only
Other-Form page 4 MDS20MDSAllForms 34.pdf Yes Yes Paper Only
Other-Form page 5 MDS20MDSAllForms 35.pdf Yes Yes Paper Only

Health Health Care Services

 

734 353
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 187,170 0 0 187,170 0 0
Annual IC Time Burden (Hours) 132,011 0 0 132,011 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.