Home Office Cost Statement and Supporting Regulations in 42 CFR 413.17 and 413.20 (CMS-287-05)

Home Office Cost Statement and Supporting Regulations in 42 CFR 413.17 and 413.20 (CMS-287-05)

OMB: 0938-0202

IC ID: 7881

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Home Office Cost Statement and Supporting Regulations in 42 CFR 413.17 and 413.20 (CMS-287-05)
 
No Modified
 
Mandatory
 
42 CFR 413.20 42 CFR 413.17

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-287-05_pr2_39_toc.pdf Yes No Printable Only
Form CMS-287-05 Home Office Cost Report Form_CMS-287-05.pdf Yes No Fillable Fileable Signable
Instruction CMS-287-05_pr2_3900_to_3990.pdf Yes No Printable Only

Health Health Care Services

 

1,686 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 1,686 0 0 145 1,541 0
Annual IC Time Burden (Hours) 785,676 0 0 67,570 718,106 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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