Renal Dialysis Facility Cost Report

Independent Renal Dialysis Facility Cost Report (CMS-265-11)

OMB: 0938-0236

IC ID: 7893

Information Collection (IC) Details

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Renal Dialysis Facility Cost Report
 
No Modified
 
Mandatory
 
42 CFR 413.20 42 CFR 413.24 42 CFR 413.178

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction R6P242i.docx Yes No Printable Only
Form CMS-265-11 Renal Dialysis Facility Cost Report R6P242f.xlsx Yes Yes Fillable Fileable Signable

Health Health Care Services

 

7,541 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,541 0 0 720 6,821 0
Annual IC Time Burden (Hours) 497,706 0 0 54,341 443,365 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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