Information Collection

Hospital, Hospital-skilled Nursing Complex And Skilled Nursing Facility Cost Report

IC 112656 under ICR 198004-0938-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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Information Collection (IC) Details

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IC Title:	HOSPITAL, HOSPITAL-SKILLED NURSING COMPLEX AND SKILLED NURSING FACILITY COST REPORT	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	HCFA-2552	No	No
Form	& 2552A	No	No
Form	THRU H	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,800	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	Previously Approved
Annual Number of Responses for this IC	10,800	3,300	7,500
Annual IC Time Burden (Hours)	759,825	620,000	139,825
Annual IC Cost Burden (Dollars)	0	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.