Information Collection

Federally Qualified Health Center Cost Report Form

IC 217774 under ICR 202412-0938-013 · OMB 0938-1298.

Documents and Forms

Document Name Document Type
Form 224-14 Federally Qualified Health Center Cost Report Form Form
R7P244i.pdf Instruction
R7P244i.pdf Instruction
224-14 Federally Qualified Health Center Cost Report R7P244f.pdf Form
224-14 Federally Qualified Health Center Cost Report R7P244f.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Federally Qualified Health Center Cost Report Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 413.20 42 CFR 413.24

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	224-14	Federally Qualified Health Center Cost Report	R7P244f.pdf		Yes	Yes	Fillable Fileable
Instruction			R7P244i.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,967	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	Previously Approved
Annual Number of Responses for this IC	2,967	77	2,890
Annual IC Time Burden (Hours)	172,086	4,466	167,620
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.