Information Collection

Skilled Nursing Facility Value-Based Purchasing Program and Quality Reporting Program

IC 267430 under ICR 202405-0938-002 · OMB 0938-1472.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1472 can be found here:

Documents and Forms

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IC Title:

Skilled Nursing Facility Value-Based Purchasing Program and Quality Reporting Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 1888(e)(6) (To search for a specific CFR, visit the Code of Federal Regulations.)

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

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: 85 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	7,680	7,680
Annual IC Cost Burden (Dollars)	813,069	813,069

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.