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483.80(d)(3)(iv)
Reform of Requirements for Long-Term Care Facilities (CMS-10573)
OMB: 0938-1363
IC ID: 254161
OMB.report
HHS/CMS
OMB 0938-1363
ICR 202407-0938-017
IC 254161
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1363 can be found here:
2024-07-25 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
483.80(d)(3)(iv)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 483.80(d)(3)(iv)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
15,600
Number of Respondents for Small Entity:
15,600
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
15,600
0
0
0
0
15,600
Annual IC Time Burden (Hours)
93,600
0
0
0
0
93,600
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.