Information Collection

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

IC 7814 under ICR 201005-0938-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

IC Title:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-2552-10 Instructions	pr2_4000_to_4009.doc	Yes	Yes	Paper Only
Other-2552-10 Instructions	pr2_4010_to_4019.6_ REV.doc	Yes	Yes	Paper Only
Other-2552-10 Instructions	pr2_4030_to_4034_REV.doc	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_A.XLS	Yes	Yes	Paper Only
Other-Specs	2552-10SPECS.zip	Yes	Yes	Printable Only
Other-2552 -10 - FORMS	255210_S_REV.XLS	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_J.XLS	Yes	Yes	Paper Only
Other-2552-10 Instructions	pr2_4040_to_4049.doc	Yes	Yes	Paper Only
Other-2552-10 Instructions	pr2_4050_to_4090.doc	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_B.XLS	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_C_REV .XLS	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_L.XLS	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_M.XLS	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_I.XLS	Yes	Yes	Paper Only
Other-2552-10 Instructions	pr2_4020_to_4029.2_REV.doc	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_D.XLS	Yes	Yes	Printable Only
Other-2552 -10 - FORMS	255210_E_REV.XLS	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_G.XLS	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_H.XLS	Yes	Yes	Paper Only
Other-2552 -10 - FORMS	255210_K.XLS	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,174

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,174	0	-1	6,175
Annual IC Time Burden (Hours)	4,155,102	64,628	0	4,090,474
Annual IC Cost Burden (Dollars)	0	0	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.