Information Collection

Community Mental Health Cost (CMHC) Report

IC 7791 under ICR 202104-0938-003 · OMB 0938-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-2088-17 Community Mental Health Cost (CMHC) Report	Form
Form CMS-2088-17 Form CMS-2088-17 Community Mental Health Cost (CMHC) Report	Form
R2P245i- Community Mental Health Center Cost Report.pdf	Instruction
R2P245i- Community Mental Health Center Cost Report.pdf	Instruction
CMS-2088-17 Form CMS-2088-17 R2P245f- Form CMS-2088-17.pdf	Form
CMS-2088-17 Form CMS-2088-17 R2P245f- Form CMS-2088-17.pdf	Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-2088-17				Yes	Yes	Fillable Fileable
Instruction					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: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	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

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.

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