Medicaid Disproportionate Share Hospital Annual Report

Medicaid Disproportionate Share Hospital Annual Reporting (CMS-R-266)

OMB: 0938-0746

IC ID: 8445

Information Collection (IC) Details

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Medicaid Disproportionate Share Hospital Annual Report
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 447.299(c)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-R-266 Annual Report CMS-R-266 - Spreadsheet (rev 11-21-2016)SG1-30.xls Yes Yes Fillable Fileable

Health Health Care Services

 

51 0
   
State, Local, and Tribal Governments
 
   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 51 0 0 0 0 51
Annual IC Time Burden (Hours) 2,142 0 0 0 0 2,142
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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