Information Collection

End-Stage Renal Disease (ESRD) Network Semi-Annual Cost Report Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112

IC 8237 under ICR 201304-0938-008 · OMB 0938-0657.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0657 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-685 End-Stage Renal Disease (ESRD) Network Semi-Annual Cost Report Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112	Form
CMS-685 FINAL_Updated_J_6_A_Instructionsdjr012513.docx.docx	Instruction
CMS-685 Network Semi Annual Reprot Network Semi Annual Report xlsx.xlsx	Form
Crosswalk ESRD Network Semi Annual Cost Report Forms.doc.doc Crosswalk	IC Document

IC Title:

End-Stage Renal Disease (ESRD) Network Semi-Annual Cost Report Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 405.2110 42 CFR 405.2112

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	CMS-685	Network Semi Annual Reprot	Network Semi Annual Report xlsx.xlsx		Yes	Yes	Fillable Fileable
Instruction			CMS-685 FINAL_Updated_J_6_A_Instructionsdjr012513.docx.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	Crosswalk ESRD Network Semi Annual Cost Report Forms.doc.doc	04/29/2013

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