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Federal forms, ICRs, and supporting documents

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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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.
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-R-116 No No


    

60 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 60 0 60 0 0 0
Annual IC Time Burden (Hours) 952 0 952 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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