Information Collection

Provider Cost Reporting Forms For Hospitals And Hospital-skilled Nursing Facility Complexes Having More Than 99 Beds

IC 112655 under ICR 197505-0938-001 · OMB 0938-0050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0050 can be found here:

Documents and Forms

Document Name Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PROVIDER COST REPORTING FORMS FOR HOSPITALS AND HOSPITAL-SKILLED NURSING FACILITY COMPLEXES HAVING MORE THAN 99 BEDS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SSA-2552	No	No
Form	SSA-2552A	No	No
Form	SSA 2552B	No	No
Form	SSA 2552C	No	No
Form	SSA 2552D	No	No
Form	SSA-2552E	No	No
Form	SSA-2552F	No	No
Form	SSA-2552G	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	7,500	7,500
Annual IC Time Burden (Hours)	139,825	139,825
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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