Medicaid Disproportionate Share Hospital Annual Reporting

Medicaid Disproportionate Share Hospital Annual Reporting (CMS-R-266)

CMS-R-266_Disclosure_Statement [rev 1-30-2014]

Medicaid Disproportionate Share Hospital Annual Reporting

OMB: 0938-0746

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PRA Disclosure Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0746. The time required to complete this information collection is estimated to average

( 42 hours) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.




























File Typeapplication/msword
File TitleAccording to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
AuthorHCFA Software Control
Last Modified ByMitch Bryman
File Modified2014-01-30
File Created2014-01-30

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