OMB control number

Requests by Hospitals for an Alternative Cost-to-Charge Ratio (CMS-10179)

OMB 0938-1020 · HHS/CMS.

OMB 0938-1020

Latest Forms, Documents, and Supporting Material

Document Name
Supporting Statement Part B.pdf Supporting Statement B
CMS-10179 Supporting Statement Part A 3-5-10 rev.doc Supporting Statement A
Requirements for Requests by Hospitals for an Alternative Cost-to-Charge Ratio and Supp. Regs. in 42CFR412.84(i)(2),412.525(a)(4)(ii), 412.525(a)(4)(iv)(A), 412.529(c)(3)(ii) and 412.529(c)(3)(iv)(A)

All Historical Document Collections

201006-0938-015 Approved without change	Extension without change of a currently approved collection	2010-06-30
200701-0938-017 Approved without change	New collection (Request for a new OMB Control Number)	2007-01-26