Information Collection

Quality Assurance For Phase Ii Of The Home Health Agency Prospective Payment Demonstration

IC 114139 under ICR 199503-0938-002 · OMB 0938-0675.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0675 can be found here:

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Information Collection (IC) Details

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IC Title:	QUALITY ASSURANCE FOR PHASE II OF THE HOME HEALTH AGENCY PROSPECTIVE PAYMENT DEMONSTRATION	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

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-174				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29,427	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	58,854	58,854
Annual IC Time Burden (Hours)	10,152	10,152
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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