Information Collection

End-Stage Renal Disease (ESRD) Network Semi-Annual Cost Report Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112

IC 8237 under ICR 202002-0938-012 · OMB 0938-0657.

Documents and Forms

Document Name Document Type
ESRD_Network_Semi-Annual_Cost_Reporting_Instructions.pdf Instruction
CMS-685 Network Semi-Annual Report ESRD_Network_Semi_Annual_Report.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	End-Stage Renal Disease (ESRD) Network Semi-Annual Cost Report Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 405.2110 42 CFR 405.2112

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			ESRD_Network_Semi-Annual_Cost_Reporting_Instructions.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-685	Network Semi-Annual Report	ESRD_Network_Semi_Annual_Report.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.