Information Collection

Data Collection Forms for a Project to Develop a Case-Mix Adjustment System for a National Home Health Prospective Payment Program

IC 8338 under ICR 199705-0938-001 · OMB 0938-0704.

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IC Title:

Data Collection Forms for a Project to Develop a Case-Mix Adjustment System for a National Home Health Prospective Payment Program

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-203				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 893,629

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 7 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	893,629	893,629
Annual IC Time Burden (Hours)	52,156	52,156
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.