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 201308-0938-011 · OMB 0938-0050 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-2552-10 Hospitals and Health Care Complex Cost Report (CMS-2552-10) Form and Instruction Modified Available
CMS-2552-10_Revisions-Crosswalk.pdf Supplementary Document Uploaded 2013-08-08 Available
CMS-2552-10_Supporting_Statement_Part_A.docx Supporting Statement A Uploaded 2013-08-08 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
7814 Hospitals and Health Care Complex Cost Report (CMS-2552-10) Form and Instruction Modified
ICR Details
0938-0050 201308-0938-011
Historical Active 201008-0938-007
HHS/CMS 20297
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 without change 09/20/2013
Retrieve Notice of Action (NOA) 08/09/2013
  Inventory as of this Action Requested Previously Approved
09/30/2016 36 Months From Approved 09/30/2013
6,171 0 6,174
4,153,083 0 4,155,102
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. 1815 Name of Statute: null
   Statute at Large: 18 Stat. 1861 Name of Statute: null
   US Code: 42 USC 1395g Name of Law: Payments to providers of services
   PL: Pub.L. 111 - 148 5503, 5504, 5508 Name of Law: Affordable Care Act
  
None
Not associated with rulemaking
  78 FR 27400 05/10/2013
78 FR 45203 07/26/2013
No
  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 6,171 6,174 0 -3 0 0
Annual Time Burden (Hours) 4,153,083 4,155,102 0 -2,019 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The changes to the burden are a result of: o The estimated number of respondents decreased by 3 (from 6,174 as of 03/02/2010 to 6,171 as of 03/11/2013). o On a per respondent basis, incorporating the added legislative requirements in the Patient Protection and Affordable Care Act (ACA) of 2010 and the Temporary Payroll Tax Cut Continuation Act of 2011 in the revised MCR has not changed burden. The hourly burden per provider is estimated to remain unchanged at 673 hours. o The standard rate per hour remains unchanged at $15.
$95,042,000
No
No
No
No
No
Uncollected
William Parham 4107864669
  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.
08/09/2013