The Medicare/Medicaid Psychiatric Hospital Survey Data Contained in 42 CFR and Supporting Regulations in 42 CFR 482.60, 482.61, and 482.62

Psychiatric Hospital Survey Data and Supporting Regulations at 42 CFR 482.60 through 482.62 (CMS-724)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0378 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-724 The Medicare/Medicaid Psychiatric Hospital Survey Data Contained in 42 CFR and Supporting Regulations in 42 CFR 482.60, 482.61, and 482.62 Form and Instruction
CMS-724 Medicare/Medicaid Psychiatric Hospital Survey Data CMS-724 Medicare - Medicaid Psychiatric Hospital Survey Data.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	The Medicare/Medicaid Psychiatric Hospital Survey Data Contained in 42 CFR and Supporting Regulations in 42 CFR 482.60, 482.61, and 482.62	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 482.60-482.62

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-724	Medicare/Medicaid Psychiatric Hospital Survey Data	CMS-724 Medicare - Medicaid Psychiatric Hospital Survey Data.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150	-50	200
Annual IC Time Burden (Hours)	75	-25	100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.