Information Collection

Billing Forms For Medicare/medicaid Hospice Demonstration- Hcfa 245, 246, And 1453dr

IC 112974 under ICR 198203-0938-004 · OMB 0938-0150.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0150 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	BILLING FORMS FOR MEDICARE/MEDICAID HOSPICE DEMONSTRATION- HCFA 245, 246, AND 1453DR	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-245,	No	No
Form	246, &	No	No
Form	1453DR	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	32,762	21,853	10,909
Annual IC Time Burden (Hours)	8,970	5,980	2,990
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.