Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64

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Documents and Forms

Document Name Document Type
Form CMS-10079 Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64 Form and Instruction
CMS-10079 Medicare Wage Index Occupational Mix Survey CMS-10079_2016_Medicare_Wage_Index_Occupational_Mix_Survey.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 412.64

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10079	Medicare Wage Index Occupational Mix Survey	CMS-10079_2016_Medicare_Wage_Index_Occupational_Mix_Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,400	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,400	-100	3,500
Annual IC Time Burden (Hours)	1,632,000	-48,000	1,680,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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