Information Collection

Medicare Collection Of Medical Information On Home Health Services On Forms Hcfa 485-487 And Intermediary Request For Medical Information On Claims To Be Processed

IC 113522 under ICR 199211-0938-002 · OMB 0938-0357.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0357 can be found here:

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Information Collection (IC) Details

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IC Title:	MEDICARE COLLECTION OF MEDICAL INFORMATION ON HOME HEALTH SERVICES ON FORMS HCFA 485-487 AND INTERMEDIARY REQUEST FOR MEDICAL INFORMATION ON CLAIMS TO BE PROCESSED	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-485-488				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,130	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,988,500	4,163,500	6,825,000
Annual IC Time Burden (Hours)	2,747,125	1,040,875	1,706,250
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.