Information Collection

Statement of Deficiencies and Plan of Correction

IC 8038 under ICR 202201-0938-003 · OMB 0938-0391.

Documents and Forms

Document Name Document Type
Form CMS-2567 Statement of Deficiencies and Plan of Correction Form and Instruction
CMS-2567 Statement of Deficiencies and Plan of Correction CMS2567. 09.27.21.pdf Form and Instruction
CMS-2567 Statement of Deficiencies and Plan of Correction CMS2567. 09.27.21.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Deficiencies and Plan of Correction	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-2567	Statement of Deficiencies and Plan of Correction	CMS2567. 09.27.21.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65,948	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	65,948	0	65,948
Annual IC Time Burden (Hours)	1,187,064	-23,312	1,210,376
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.