Information Collection

?495.24(e) Objectives/Measures (hospitals/CAHs)

IC 216082 under ICR 201812-0938-010 · OMB 0938-1278.

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Information Collection (IC) Details

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IC Title:	§495.24(e) Objectives/Measures (hospitals/CAHs)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 495.24

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,300	-1,600	4,900
Annual IC Time Burden (Hours)	23,694	-9,920	33,614
Annual IC Cost Burden (Dollars)	0	0	0

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