Information Collection

Year 1 (IC 1 and IC 3) - Existing Facilities

IC 248121 under ICR 202506-0938-010 · OMB 0938-1402.

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Information Collection (IC) Details

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IC Title:	Year 1 (IC 1 and IC 3) - Existing Facilities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 483.460(a)(4) 42 CFR 483.460(a)(4)(ii)(iii)(iv)

Information Collection 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: 5,523	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: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	5,523	-249	5,772
Annual IC Time Burden (Hours)	27,615	-21,447	49,062
Annual IC Cost Burden (Dollars)	0	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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