Information Collection

Community Mental Health Cost (CMHC) Report

IC 7791 under ICR 202412-0938-015 · OMB 0938-0037.

Documents and Forms

Document Name Document Type
Form CMS-2088-17 Community Mental Health Cost (CMHC) Report Form
R4P245i.pdf Instruction
R4P245i.pdf Instruction
CMS-2088-17 Community Mental Health Cost Center Report R4P245f.xlsx Form
CMS-2088-17 Community Mental Health Cost Center Report R4P245f.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community Mental Health Cost (CMHC) Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 410.110 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-2088-17	Community Mental Health Cost Center Report	R4P245f.xlsx		Yes	Yes	Fillable Fileable
Instruction			R4P245i.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 191	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	191	7	184
Annual IC Time Burden (Hours)	17,190	630	16,560
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.