HOSPICE STATEMENTS OF REIMBURSEMENTS

ICR 198407-0938-003

OMB: 0938-0177

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
113037 Migrated
ICR Details
0938-0177 198407-0938-003
Historical Active 198306-0938-005
HHS/CMS
HOSPICE STATEMENTS OF REIMBURSEMENTS
Revision of a currently approved collection   No
Regular
Approved without change 08/13/1984
Retrieve Notice of Action (NOA) 07/20/1984
  Inventory as of this Action Requested Previously Approved
03/31/1985 03/31/1985 08/31/1984
150 0 120
3,105 0 2,724
0 0 0

THE COST REPORTS WILL BE USED BY HCFA'S OFFICE OF DIRECT REIMBURSEMENT TO ENSURE PROPER AND TIMELY PAYMENTS TO THE HOSPICE FACILITIES. ODR WILL PERFORM DESK REVIEWS OF THE COST REPORTS AND PREPARE INTERIM PAYMENTS AND FINAL SETTLEMENTS FOR HOSPICE REIMBURSEMENTS. THE AFFECTED PUBLIC INCLUDES PRIVATE NONPROFIT ORGANIZATIONS AND STATE UNVIVERSITY MEDICAL CENTERS WHICH OFFER CARE FOR THE TERMINALLY ILL.

None
None


No

1
IC Title Form No. Form Name
HOSPICE STATEMENTS OF REIMBURSEMENTS HCFA-278, 278Q, 279,279Q, 280, 280Q

  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 150 120 0 0 30 0
Annual Time Burden (Hours) 3,105 2,724 0 0 381 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
07/20/1984


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