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End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133

IC 8062 under ICR 201612-0938-024 · OMB 0938-0447.

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End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133
 
No Modified
 
Mandatory
 
20 CFR 422.Subpart E 45 CFR 5.5b 42 CFR 405.2133 20 CFR 401..

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-2744A END STAGE RENAL DISEASE MEDICAL INFORMATION SYSTEM ESRD FACILITY SURVEY CMS-2744A.pdf Yes Yes Fillable Fileable
Form CMS-2744B END STAGE RENAL DISEASE MEDICAL INFORMATION SYSTEM ESRD FACILITY SURVEY (TRANSPLANT CENTERS ONLY) CMS-2744B.pdf Yes Yes Fillable Fileable
Instruction CMS-2744.Current facility survey instructions.pdf Yes No Printable Only

Health Health Care Services

End Stage Renal Disease (ESRD) Program Management and Medical Information System (PMMIS)  72 FR 26126

5,964 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 5,964 0 0 0 0 5,964
Annual IC Time Burden (Hours) 47,712 0 0 0 0 47,712
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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