Information Collection

A Study Of Medicare Patients With Very Long Home Health Episodes -- Task 3.1, Home Care Quality Studies -- Hcfa Contract No. 500-89-0056

IC 114085 under ICR 199401-0938-001 · OMB 0938-0620.

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IC Title:

A STUDY OF MEDICARE PATIENTS WITH VERY LONG HOME HEALTH EPISODES -- TASK 3.1, HOME CARE QUALITY STUDIES -- HCFA CONTRACT NO. 500-89-0056

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-146				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	449	449
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.