Information Collection

Skilled Nursing Facility and Skilled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106

IC 8084 under ICR 202405-0938-031 · OMB 0938-0463.

Documents and Forms

Document Name Document Type
Form CMS-2540-24 Skilled Nursing Facility and Skilled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106 Form
R1P249i.docx Instruction
R1P249i.docx Instruction
CMS-2540-24 CMS-2540-24 R1P249f.xlsx Form
CMS-2540-24 CMS-2540-24 R1P249f.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Skilled Nursing Facility and Skilled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.24 42 CFR 413.20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-2540-24	CMS-2540-24	R1P249f.xlsx		Yes	Yes	Fillable Fileable
Instruction			R1P249i.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,189	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 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	14,189	-297	14,486
Annual IC Time Burden (Hours)	2,866,178	-59,994	2,926,172
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.