PIP QUARTERLY REPORT FOR HOME HEALTH AGENCIES

ICR 198304-0938-007

OMB: 0938-0153

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
112990 Migrated
ICR Details
0938-0153 198304-0938-007
Historical Active 198102-0938-006
HHS/CMS
PIP QUARTERLY REPORT FOR HOME HEALTH AGENCIES
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 06/22/1983
Retrieve Notice of Action (NOA) 04/29/1983
  Inventory as of this Action Requested Previously Approved
06/30/1984 06/30/1984
392 0 0
5,488 0 0
0 0 0

THE OFFICE OF DIRECT REIMBURSEMENT, HCFA, USES THIS FORM TO DETERMINE THE MEDICARE UTILIZATION AND COSTS OF HOME HEALTH AGENCIES WHICH RECEIVE PERIODIC INTERIM PAYMENTS AND WHICH ARE SERVICED BY ODR.

None
None


No

1
IC Title Form No. Form Name
PIP QUARTERLY REPORT FOR HOME HEALTH AGENCIES HCFA-243

  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 392 0 0 392 0 0
Annual Time Burden (Hours) 5,488 0 0 5,488 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
04/29/1983


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