IMPLEMENTATION OF THE HOSPICE CONCEPT

ICR 197910-0925-001

OMB: 0925-0034

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
111239
Migrated
ICR Details
0925-0034 197910-0925-001
Historical Active 197907-0925-001
HHS/NIH
IMPLEMENTATION OF THE HOSPICE CONCEPT
Revision of a currently approved collection   No
Regular
Approved without change 11/07/1979
Retrieve Notice of Action (NOA) 10/15/1979
  Inventory as of this Action Requested Previously Approved
08/31/1981 08/31/1981 08/31/1981
2,186 0 1,800
1,629 0 1,350
0 0 0

PURPOSE IS TO PROVIDE AN ACCURATE AND THROUGH DESCRIPTION OF THREE DIFFERENT MODALITIES OF COMPREHENSIVE HOSPICE CARE, INCLUDING HOME CARE, INPATIENT CARE AND A COMBINATION OF HOME AND INPATIENT CARE WITHIN THREE DIFFERENT SETTINGS, A COMMUNITY HOSPITAL, A NURSING HOME AND A HEALTH MAINTENANCE ORGANIZATION; DESCRIBING COSTS AND SERVICES IN EACH HOSPICE SETTING; AND EXAMINING STAFFING PATTERNS AS THEY IMPACT ON HOSPICE FUNCTIONING

None
None


No

1
IC Title Form No. Form Name
IMPLEMENTATION OF THE HOSPICE CONCEPT

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,186 1,800 0 0 386 0
Annual Time Burden (Hours) 1,629 1,350 0 0 279 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/15/1979


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