Information Collection

Home Health Medicare Conditions of Participation (CoP) Information Collection Requirements as Outlined in Regulation -- 42 CFR 484

IC 8005 under ICR 200103-0938-009 · OMB 0938-0365.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0365 can be found here:

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Information Collection (IC) Details

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IC Title:	Home Health Medicare Conditions of Participation (CoP) Information Collection Requirements as Outlined in Regulation -- 42 CFR 484	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-39				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,500	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	Previously Approved
Annual Number of Responses for this IC	7,500	-2,703	10,203
Annual IC Time Burden (Hours)	862,585	776,577	86,008
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.