Information Collection

Information Collection Requirements For Sole Community Home Health Agencies At 42 Cfr 424.22(b) (2), (f), And (g)

IC 113863 under ICR 199207-0938-004 · OMB 0938-0489.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0489 can be found here:

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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 424.22(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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20	0	20
Annual IC Time Burden (Hours)	40	-60	100
Annual IC Cost Burden (Dollars)	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.