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Home Health Agency Request For Certification Paperwork Burden Associated With Home Health

IC 112498 under ICR 198212-0938-004 · OMB 0938-0011.

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HOME HEALTH AGENCY REQUEST FOR CERTIFICATION PAPERWORK BURDEN ASSOCIATED WITH HOME HEALTH
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA 1515 No No
Form HCFA R-15 No No


    

1,860 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,860 0 0 0 0 1,860
Annual IC Time Burden (Hours) 15,500 0 0 0 0 15,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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