Information Collection

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

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

HOME HEALTH AGENCY REQUEST FOR CERTIFICATION PAPERWORK BURDEN ASSOCIATED WITH HOME HEALTH

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:

table that charts list of instruments
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

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,860

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,860	1,860
Annual IC Time Burden (Hours)	15,500	15,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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