HOSPICE CORE SERVICE: NURSING (INFORMATION COLLECTION REQUIREMENT IN SEC. 42 CFR 418.83)

ICR 198903-0938-009

OMB: 0938-0475

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0475 198903-0938-009
Historical Active 198604-0938-005
HHS/CMS
HOSPICE CORE SERVICE: NURSING (INFORMATION COLLECTION REQUIREMENT IN SEC. 42 CFR 418.83)
Extension without change of a currently approved collection   No
Regular
Approved without change 05/18/1989
Retrieve Notice of Action (NOA) 03/22/1989
  Inventory as of this Action Requested Previously Approved
05/31/1992 05/31/1992 06/30/1989
1 0 1
1 0 1
0 0 0

THIS INFORMATION COLLECTION PERMITS HOSPICES TO REQUEST A WAIVER TO FURNISH DIRECT NURSING SERVICES. IN ORDER TO REQUEST A WAIVER, HOSPICES WOULD HAVE TO MEET CERTAIN CONDITIONS AND DEMONSTRATE THEIR EFFORTS TO HIRE NURSES AS WELL AS ESTABLISHING THAT THEY WERE OPERATIN AS A HOSPICE BEFORE JANUARY 1, 1983.

None
None


No

1
IC Title Form No. Form Name
HOSPICE CORE SERVICE: NURSING (INFORMATION COLLECTION REQUIREMENT IN SEC. 42 CFR 418.83) HCFA-R-66

  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 1 1 0 0 0 0
Annual Time Burden (Hours) 1 1 0 0 0 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.
03/22/1989


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