Home Office Cost Statement
and Supporting Regulations in 42 CFR 413.17 and 413.20
(CMS-287-21)
Reinstatement with change of a previously approved collection
No
Regular
12/24/2020
Requested
Previously Approved
36 Months From Approved
1,626
0
757,716
0
0
0
The Form CMS-287-05 is filed annually
by Chain Home Offices to report the information necessary for the
determination of Medicare reimbursement to components of chain
organizations.
Statute at
Large: 18
Stat. 1833 Name of Statute: null
Statute at Large: 18
Stat. 1815 Name of Statute: null
The burden has been adjusted
downward to account for a decrease in the number of respondents.
The per task burden remains unchanged.
$7,745,451
No
No
No
No
No
No
No
William Parham
4107864669
No
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.