Information Collection

Home Health Services under Hospital Insurance, Manual Instructions and Supporting Regulations in 42 CFR 409.40-50, 410.36, 410.170, 411.4-.15, 421.100, 424.22, 484.18, and 489.21

IC 7991 under ICR 199710-0938-002 · OMB 0938-0357.

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Information Collection (IC) Details

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IC Title:	Home Health Services under Hospital Insurance, Manual Instructions and Supporting Regulations in 42 CFR 409.40-50, 410.36, 410.170, 411.4-.15, 421.100, 424.22, 484.18, and 489.21	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	485				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,044	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,080,000	3,276,000	6,804,000
Annual IC Time Burden (Hours)	2,520,000	-882,000	3,402,000
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.