Independent Renal Dialysis Facility Cost Report and Supporting Regulations 42 CFR 413.20 and 42 CFR 413.24

ICR 201008-0938-022

OMB: 0938-0236

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2010-08-25
ICR Details
0938-0236 201008-0938-022
Historical Active 200705-0938-007
HHS/CMS
Independent Renal Dialysis Facility Cost Report and Supporting Regulations 42 CFR 413.20 and 42 CFR 413.24
Extension without change of a currently approved collection   No
Regular
Approved without change 10/04/2010
Retrieve Notice of Action (NOA) 08/30/2010
  Inventory as of this Action Requested Previously Approved
10/31/2013 36 Months From Approved 10/31/2010
5,508 0 4,885
275,400 0 957,460
0 0 0

The Independent Renal Dialysis Facility Cost Report provides for the determination and allocation of costs to the components of the facility in order to establish a proper basis for Medicare payment.

US Code: 42 USC 1395g Name of Law: Payment of Providers of Services
  
None

Not associated with rulemaking

  75 FR 30030 05/28/2010
75 FR 49494 08/13/2010
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,508 4,885 0 0 623 0
Annual Time Burden (Hours) 275,400 957,460 0 0 -682,060 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$43,555,200
No
No
No
Uncollected
No
Uncollected
Bonnie Harkless 4107865666

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/30/2010


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