Information Collection

Hospital Annual Recertification

IC 190348 under ICR 201504-0915-001 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Hospital Annual Recertification	Form
2 Recert-Critical Access; Sole-community; Rural-Referral c Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised.pdf	Form
1 Public Ownership-Revised.docx Hospital Recertification-DSH.pdf	Form
3 Recert-Free standing Cancer Hospital (Orphan Drug)-Revis Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf	Form

IC Title:

Hospital Annual Recertification

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Public Ownership-Revised.docx	Hospital Recertification-DSH.pdf	Yes	Yes	Fillable Fileable
Form	3	Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf	Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf	Yes	Yes	Fillable Fileable
Form	2	Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised	Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,134

Number of Respondents for Small Entity: 280

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	12,804	7,962	4,842
Annual IC Time Burden (Hours)	3,201	780	2,421
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.