Information Collection

Home Health Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106

IC 7765 under ICR 200103-0938-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106	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-1728-94				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,310	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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,310	42	-1,682	8,950
Annual IC Time Burden (Hours)	1,311,060	7,310	-295,950	1,599,700
Annual IC Cost Burden (Dollars)	0	0	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.