Information Collection

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.

IC 113948 under ICR 198902-0938-003 · OMB 0938-0542.

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Information Collection (IC) Details

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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:

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-R-116				No	No

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

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