Information Collection

Information Collection Requirements For Sole Community Home Health Agencies At 42 Cfr 405.1633(b)(2), (f) And (g)

IC 113862 under ICR 198907-0938-007 · OMB 0938-0489.

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENTS FOR SOLE COMMUNITY HOME HEALTH AGENCIES AT 42 CFR 405.1633(B)(2), (F) AND (G)	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-85				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

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