Independent Renal Dialysis Facility Cost Report and Supporting Regulations 42 CFR 413.20, 42 CFR 413.24 and 42 CFR 413.178

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

OMB: 0938-0236

IC ID: 7893

Information Collection (IC) Details

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Independent Renal Dialysis Facility Cost Report and Supporting Regulations 42 CFR 413.20, 42 CFR 413.24 and 42 CFR 413.178
 
No Modified
 
Mandatory
 
42 CFR 413.20 42 CFR 413.24 42 CFR 413.178

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-265-11 Independent Renal Dialysis Facility Cost Report Form CMS-265-11 Forms.xls Yes Yes Fillable Fileable Signable
Instruction Form CMS-265-11 Instructions.pdf Yes No Printable Only

Health Health Care Services

 

5,677 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,677 0 23 0 0 5,654
Annual IC Time Burden (Hours) 369,005 0 1,495 0 0 367,510
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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