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 On Hcfa 488

IC 113525 under ICR 199409-0938-003 · OMB 0938-0357.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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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 ON HCFA 488	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.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA 486	No	No
Form	HCFA 487	No	No
Form	HCFA 488	No	No
Form	HCFA 485	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,800	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
Annual Number of Responses for this IC	6,804,000	6,804,000
Annual IC Time Burden (Hours)	3,402,000	3,402,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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