OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Hospitals and Health Care Complex Cost Report and Supporting Regulation in 42 CFR 413.20 and 413.24

ICR 201005-0938-007 · OMB 0938-0050 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
30-day Comment Respones.docx Supplementary Document Uploaded 2010-08-06 Repair queued
60 days comments chart 4-16-2010.xls Supplementary Document Uploaded 2010-05-04 Available
CMS-2552-10 Revisions - Crosswalk from old to new.doc Supplementary Document Uploaded 2010-05-04 Repair queued
Supporting Statement - Part A.doc Supporting Statement A Uploaded 2010-05-04 Available
IC Document Collections
IC IDCollectionTypeStatusForm
7814 Hospitals and Health Care Complex Cost Report (CMS-2552-96) Other-2552-10 Instructions Modified
ICR Details
0938-0050 201005-0938-007
Historical Active 200802-0938-004
HHS/CMS
Hospitals and Health Care Complex Cost Report and Supporting Regulation in 42 CFR 413.20 and 413.24
Revision of a currently approved collection   No
Regular
Approved with change 08/11/2010
Retrieve Notice of Action (NOA) 05/13/2010
  Inventory as of this Action Requested Previously Approved
08/31/2013 36 Months From Approved 06/30/2011
6,174 0 6,175
4,155,102 0 4,090,474
0 0 0
Form CMS 2552-10 is used by hospitals participating in the Medicare program to report the health care costs to determine the amount of reimbursable costs for services rendered to Medicare beneficiaries.
Statute at Large: 18 Stat. 1861 Name of Statute: null
   Statute at Large: 18 Stat. 1815 Name of Statute: null
  
None
Not associated with rulemaking
  74 FR 31738 07/02/2009
75 FR 22810 04/30/2010
Yes
1
IC Title Form No. Form Name
Hospitals and Health Care Complex Cost Report (CMS-2552-96)
  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 6,174 6,175 0 0 -1 0
Annual Time Burden (Hours) 4,155,102 4,090,474 0 64,628 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Revising the Hospital and Hospital Health Care Complex Cost Report (MCR) -- prior to inclusion of the FORM CMS-339 -- to streamline data collection, clarify instructions and definitions, and eliminate obsolete worksheets decreased the burden. Incorporating Provider Cost Report Reimbursement Questionnaire, FORM CMS-339, in the revised MCR increased the burden. The net effect of changes to the MCR is an increase in the burden. See Supporting Statement for elaboration of the burden changes.
$95,042,000
No
No
No
Uncollected
No
Uncollected
Bonnie Harkless 4107865666
  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.
05/13/2010