Information Collection

Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare Program

IC 7832 under ICR 201803-0938-005 · OMB 0938-0074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0074 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-29 Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare Program	Form and Instruction
CMS-29 Verification of Clinic Data - Rural Health Clinic Progra CMS29 form. 04.10.18.pdf	Form and Instruction

IC Title:

Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Form and Instruction	CMS-29	Verification of Clinic Data - Rural Health Clinic Program	CMS29 form. 04.10.18.pdf		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 210

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: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	210	-690	900
Annual IC Time Burden (Hours)	70	-80	150
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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