Information Collection

Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106

IC 8084 under ICR 201006-0938-014 · OMB 0938-0463.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0463 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2pr2_4100_to_4107.doc	Instruction
pr2_41_toc.doc	Instruction
pr2_4108_to_4120.doc	Instruction
pr2_4121_to_4130.2.doc	Instruction
pr2_4131_to_4161.doc	Instruction
pr2_4190.doc	Instruction
CMS-2540-10 Skilled Nursing Facility and Skilled Facility Health Car 06-10 DRAFT 2540-10P.xls	Form

IC Title:

Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.24 42 CFR 413.20

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			2pr2_4100_to_4107.doc	Yes	Yes	Printable Only
Instruction			pr2_41_toc.doc	Yes	Yes	Printable Only
Instruction			pr2_4108_to_4120.doc	Yes	Yes	Printable Only
Instruction			pr2_4121_to_4130.2.doc	Yes	Yes	Printable Only
Instruction			pr2_4131_to_4161.doc	Yes	Yes	Printable Only
Instruction			pr2_4190.doc	Yes	Yes	Printable Only
Form	CMS-2540-10	Skilled Nursing Facility and Skilled Facility Health Care Complex Cost Report	06-10 DRAFT 2540-10P.xls	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,037

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	15,037	0	15,037
Annual IC Time Burden (Hours)	2,706,660	-240,592	2,947,252
Annual IC Cost Burden (Dollars)	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.