Information Collection

Home Health Services Under Hospital Insurance, Manuel 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 7992 under ICR 200104-0938-004 · OMB 0938-0357.

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Information Collection (IC) Details

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IC Title:	Home Health Services Under Hospital Insurance, Manuel 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	HCFA-485				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,322	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 98 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,580,000	5,580,000
Annual IC Time Burden (Hours)	1,395,000	1,395,000
Annual IC Cost Burden (Dollars)	0	0

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Title	Document	Date Uploaded

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