Community Mental Health Cost (CMHC) Report

Community Mental Health Center (CMHC) Cost Report (CMS-2088-17)

Documents and Forms

Document Name Document Type
Form CMS-2088-17 Community Mental Health Cost (CMHC) Report Form
R2P245i- Community Mental Health Center Cost Report.pdf Instruction
CMS-2088-17 Form CMS-2088-17 R2P245f- Form CMS-2088-17.pdf Form

Information Collection (IC) Details

IC Title:	Community Mental Health Cost (CMHC) Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.20 42 CFR 410.110 42 CFR 413.24

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-2088-17	Form CMS-2088-17	R2P245f- Form CMS-2088-17.pdf		Yes	Yes	Fillable Fileable
Instruction			R2P245i- Community Mental Health Center Cost Report.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 184	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	184	-35	219
Annual IC Time Burden (Hours)	16,560	-3,150	19,710
Annual IC Cost Burden (Dollars)	0	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.