Information Collection

Fee-For-Service (FFS) Survey

IC 194257 under ICR 202406-0938-010 · OMB 0938-0732.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0732 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-246 Fee-For-Service (FFS) Survey	Form and Instruction
CMS-R-246 Fee-For-Service (FFS) Survey 2025-FFS-Survey.docx	Form and Instruction
CMS-R-246 Fee-For-Service (FFS) Survey 2025-FFS-Survey 11_12_2024.pdf	Form and Instruction

IC Title:

Fee-For-Service (FFS) Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 423.159 42 CFR 422.152(b)

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-R-246	Fee-For-Service (FFS) Survey	2025-FFS-Survey 11_12_2024.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act of 1974: HPMS # 09-70-4004

FR Citation: 63 FR 43187

Number of Respondents: 275,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	275,000	275,000
Annual IC Time Burden (Hours)	68,750	68,750
Annual IC Cost Burden (Dollars)	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.