Diagnosis Related Groups (DRG) Reimbursement (Two Parts)

Documents and Forms

Document Name Document Type
0720-0017_SAMPLE collection instrument_ DRG Reimbursement.pdf Other-Letter with instructions
0720-0017_SAMPLE collection instrument_ DRG Reimbursement.pdf Other-Letter with instructions

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Diagnosis Related Groups (DRG) Reimbursement (Two Parts)	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
Other-Letter with instructions			0720-0017_SAMPLE collection instrument_ DRG Reimbursement.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,600	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: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,600	0	5,600
Annual IC Time Burden (Hours)	5,600	-2,800	8,400
Annual IC Cost Burden (Dollars)	264,824	-132,412	397,236

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.