Information Collection

Home Health Advance Beneficiary Notices of Liability and Supporting Regulations in 42 CFR 4984.10(a)

IC 8541 under ICR 200011-0938-004 · OMB 0938-0781.

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Information Collection (IC) Details

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IC Title:	Home Health Advance Beneficiary Notices of Liability and Supporting Regulations in 42 CFR 4984.10(a)	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-296				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	108,000	-252,000	360,000
Annual IC Time Burden (Hours)	30,000	-30,000	60,000
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.