Information Collection Request

Statement of Deficiencies and Plan of Correction (CMS-2567)

ICR 202201-0938-003 · OMB 0938-0391 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-2567 Statement of Deficiencies and Plan of Correction Form and Instruction Modified Repair queued
Response to Public Comment to CMS 2567. 01.04.22.docx Supplementary Document Uploaded 2022-01-07 Repair queued
CMS-2567 Supporting Statement 1-7-22.docx Supporting Statement A Uploaded 2022-01-07 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
8038 Statement of Deficiencies and Plan of Correction Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 02/28/2022
65,948 65,948
1,187,064 1,210,376
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Statement of Deficiencies and Plan of Correction CMS-2567 Statement of Deficiencies and Plan of Correction

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 65,948 65,948 0 0 0 0
Annual Time Burden (Hours) 1,187,064 1,210,376 0 0 -23,312 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No