Information Collection

329 Requirement For Narrative Notation Of Home Health Visit In Medical Records

IC 113056 under ICR 198310-0938-026 · OMB 0938-0188.

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IC Title:

329 REQUIREMENT FOR NARRATIVE NOTATION OF HOME HEALTH VISIT IN MEDICAL RECORDS

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-296				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 480

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,600	10,384	3,216
Annual IC Time Burden (Hours)	4,523	3,452	1,071
Annual IC Cost Burden (Dollars)	0	0	0

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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.