Information Collection

Skilled Nursing Facility Value-Based Purchasing Program and Quality Reporting Program

IC 267430 under ICR 202405-0938-002 · OMB 0938-1472.

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Information Collection (IC) Details

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IC Title:	Skilled Nursing Facility Value-Based Purchasing Program and Quality Reporting Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 1888(e)(6) (To search for a specific CFR, visit the Code of Federal Regulations.)

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: 1,500	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: 85 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	7,680	7,680
Annual IC Cost Burden (Dollars)	813,069	813,069

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