Information Collection

Information Collection Requirements In 42 Cfr Parts 405.1202 405.1221, 1223, & 1228, 1229-conditions Of Participation For Home Health Agencies

IC 113552 under ICR 198509-0938-004 · OMB 0938-0365.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0365 can be found here:

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENTS IN 42 CFR PARTS 405.1202 405.1221, 1223, & 1228, 1229-CONDITIONS OF PARTICIPATION FOR HOME HEALTH AGENCIES	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-R-39				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,280	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	Previously Approved
Annual Number of Responses for this IC	4,280	4,280
Annual IC Time Burden (Hours)	141,260	141,260
Annual IC Cost Burden (Dollars)	0	0

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Title	Document	Date Uploaded

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