Information Collection

The Medicare/Medicaid Psychiatric Hospital Survey Data Contained in 42 CFR and Supporting Regulations in 42 CFR 482.60, 482.61, and 482.62

IC 8018 under ICR 202104-0938-006 · OMB 0938-0378.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-724 The Medicare/Medicaid Psychiatric Hospital Survey Data Contained in 42 CFR and Supporting Regulations in 42 CFR 482.60, 482.61, and 482.62	Form and Instruction
CMS-724 Medicare/Medicaid Psychiatric Hospital Survey Data CMS-724 form. 508 compliance.02.19.21.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 482.60-482.62

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-724	Medicare/Medicaid Psychiatric Hospital Survey Data	CMS-724 form. 508 compliance.02.19.21.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 191

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	191	41	150
Annual IC Time Burden (Hours)	96	21	75
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.