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Federal forms, ICRs, and supporting documents

Information Collection Request

PROVIDER COST REPORTING FORMS FOR HOSPITALS AND HOSPITAL-SKILLED NURSING FACILITY COMPLEXES HAVING MORE THAN 99 BEDS

ICR 197505-0938-001 · OMB 0938-0050 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
112655 PROVIDER COST REPORTING FORMS FOR HOSPITALS AND HOSPITAL-SKILLED NURSING FACILITY COMPLEXES HAVING MORE THAN 99 BEDS Form Migrated
ICR Details
0938-0050 197505-0938-001
Historical Active
HHS/CMS
PROVIDER COST REPORTING FORMS FOR HOSPITALS AND HOSPITAL-SKILLED NURSING FACILITY COMPLEXES HAVING MORE THAN 99 BEDS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/12/1975
Retrieve Notice of Action (NOA) 05/12/1975
  Inventory as of this Action Requested Previously Approved
06/30/1980 06/30/1980
7,500 0 0
139,825 0 0
0 0 0

None
None
No
1
IC Title Form No. Form Name
PROVIDER COST REPORTING FORMS FOR HOSPITALS AND HOSPITAL-SKILLED NURSING FACILITY COMPLEXES HAVING MORE THAN 99 BEDS SSA-2552, SSA-2552A, SSA 2552B, SSA 2552C, SSA 2552D, SSA-2552E, SSA-2552F, SSA-2552G
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 7,500 0 0 0 7,500 0
Annual Time Burden (Hours) 139,825 0 0 0 139,825 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/12/1975