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Agency Characteristics Form For The National Home Health Agency Prospective Payment Demonstration

IC 114001 under ICR 199311-0938-004 · OMB 0938-0569.

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AGENCY CHARACTERISTICS FORM FOR THE NATIONAL HOME HEALTH AGENCY PROSPECTIVE PAYMENT DEMONSTRATION
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-443 No No
Form HCFA-444 No No


    

111 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 111 0 111 0 0 0
Annual IC Time Burden (Hours) 72 0 72 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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