Information Collection

Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106

IC 8084 under ICR 201006-0938-014 · OMB 0938-0463.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0463 can be found here:

Documents and Forms

Document Name Document Type
2pr2_4100_to_4107.doc Instruction
pr2_41_toc.doc Instruction
pr2_4108_to_4120.doc Instruction
pr2_4121_to_4130.2.doc Instruction
pr2_4131_to_4161.doc Instruction
pr2_4190.doc Instruction
CMS-2540-10 Skilled Nursing Facility and Skilled Facility Health Car 06-10 DRAFT 2540-10P.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Skilled Nursing Facility and Silled Nursing Facility Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.24 42 CFR 413.20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			2pr2_4100_to_4107.doc	Yes	Yes	Printable Only
Instruction			pr2_41_toc.doc	Yes	Yes	Printable Only
Instruction			pr2_4108_to_4120.doc	Yes	Yes	Printable Only
Instruction			pr2_4121_to_4130.2.doc	Yes	Yes	Printable Only
Instruction			pr2_4131_to_4161.doc	Yes	Yes	Printable Only
Instruction			pr2_4190.doc	Yes	Yes	Printable Only
Form	CMS-2540-10	Skilled Nursing Facility and Skilled Facility Health Care Complex Cost Report	06-10 DRAFT 2540-10P.xls	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,037	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15,037	0	15,037
Annual IC Time Burden (Hours)	2,706,660	-240,592	2,947,252
Annual IC Cost Burden (Dollars)	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.