Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

ICR 200411-0938-008

OMB: 0938-0758

Federal Form Document

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Name
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ICR Details
0938-0758 200411-0938-008
Historical Active 200201-0938-008
HHS/CMS
Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24
Extension without change of a currently approved collection   No
Regular
Approved without change 01/27/2005
Retrieve Notice of Action (NOA) 11/30/2004
  Inventory as of this Action Requested Previously Approved
01/31/2008 01/31/2008 03/31/2005
1,720 0 1,720
302,720 0 302,720
0 0 0

The hospice cost report is the mechanism used to collect data from providers for rate evaluations for the Prospective Payment System (PPS). Once CMS obtains this information, we will update the PPS as mandated by Congress.

None
None


No

1
IC Title Form No. Form Name
Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24 CMS-R-249

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,720 1,720 0 0 0 0
Annual Time Burden (Hours) 302,720 302,720 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/30/2004


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