Information Collection

Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64

IC 8747 under ICR 201001-0938-004 · OMB 0938-0907.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0907 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10079 Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64	Form and Instruction
CMS-10079 Medicare Wage Index Occupational Mix Survey MEDICARE WAGE INDEX OCCUPATIONAL MIX SURVEY.doc	Form and Instruction
Medicare Wage Index Occupational Mix Survey Summary of Changes.doc Medicare Wage Index Occupational Mix Survey Summary of Changes	IC Document

IC Title:

Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 412.64

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 and Instruction	CMS-10079	Medicare Wage Index Occupational Mix Survey	MEDICARE WAGE INDEX OCCUPATIONAL MIX SURVEY.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,522

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,522	-78	3,600
Annual IC Time Burden (Hours)	1,690,560	-37,440	1,728,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Medicare Wage Index Occupational Mix Survey Summary of Changes	Medicare Wage Index Occupational Mix Survey Summary of Changes.doc	01/11/2010

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