Information Collection

Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106

IC 8084 under ICR 201509-0938-003 · OMB 0938-0463.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0463 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-2540-10-Instructions .pdf	Instruction
CMS-2540-10 Cost Report CMS-2540-10_Cost_Report.xlsx	Form
CMS-2540-10 Revisions Hospice-Crosswalk-AC-07-09-15.pdf CMS-2540-10 Crosswalk	IC Document

IC Title:

Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.24 42 CFR 413.20

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
Instruction			CMS-2540-10-Instructions .pdf		Yes	No	Printable Only
Form	CMS-2540-10	Cost Report	CMS-2540-10_Cost_Report.xlsx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,398

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

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	14,398	213	14,185
Annual IC Time Burden (Hours)	2,908,396	43,026	2,865,370
Annual IC Cost Burden (Dollars)	41,875,085,608	41,875,085,608	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-2540-10 Crosswalk	CMS-2540-10 Revisions Hospice-Crosswalk-AC-07-09-15.pdf	09/03/2015

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