Medicare Provider Cost Report Reimbursement Questionnaire (exhibit 1)

Medicare Provider Cost Report Reimbursement Questionnaire and Supporting Regulations in 42 CFR 413.20, 413.24, and 415.60

OMB: 0938-0301

IC ID: 37886

Information Collection (IC) Details

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Medicare Provider Cost Report Reimbursement Questionnaire (exhibit 1)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 415.60 42 CFR 413.20 42 CFR 413.24

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-339 Medicare Provider Cost Report Reimbursement Questionnaire PRM-2 Chapter 11 Transmittal 8.docx Yes Yes Fillable Fileable

Health Health Care Services

 

2,273 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 2,273 0 0 -15,666 17,939 0
Annual IC Time Burden (Hours) 6,819 0 0 -46,998 53,817 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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