Information Collection

Home Health Agency, And Comprehensive Outpatient Rehabilitation Facility, Billing

IC 112504 under ICR 198302-0938-007 · OMB 0938-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0012 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	HOME HEALTH AGENCY, AND COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY, BILLING	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-1487				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,976	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	4,321,200	150,000	4,171,200
Annual IC Time Burden (Hours)	720,200	25,000	695,200
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.