Information Collection

Home Health Agency Cost Report -- 42 CFR 413.20 and 413.24

IC 7762 under ICR 199706-0938-006 · OMB 0938-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0022 can be found here:

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Information Collection (IC) Details

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IC Title:	Home Health Agency Cost Report -- 42 CFR 413.20 and 413.24	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-1728				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,950	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	Previously Approved
Annual Number of Responses for this IC	8,950	4,126	4,824
Annual IC Time Burden (Hours)	1,575,200	726,176	849,024
Annual IC Cost Burden (Dollars)	0	0	0

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