Medicare - Information Collection Requirements For Home Health Agencies & Hospices At 42 Cfr 421.117(e) And (f) And Section 140 Of The Hha & Hospice Manuals, Etc.

MEDICARE - INFORMATION COLLECTION REQUIREMENTS FOR HOME HEALTH AGENCIES & HOSPICES AT 42 CFR 421.117(E) AND (F) AND SECTION 140 OF THE HHA & HOSPICE MANUALS, ETC.

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	MEDICARE - INFORMATION COLLECTION REQUIREMENTS FOR HOME HEALTH AGENCIES & HOSPICES AT 42 CFR 421.117(E) AND (F) AND SECTION 140 OF THE HHA & HOSPICE MANUALS, ETC.	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-116				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	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
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	952	952
Annual IC Cost Burden (Dollars)	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.