Information Collection

OASIS Study: OASIS Cost and Benefit Survey of Home Health Agencies and Supporting Regulations 42 CFR Parts 484 and 488

IC 8791 under ICR 200502-0938-001 · OMB 0938-0940.

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IC Title:

OASIS Study: OASIS Cost and Benefit Survey of Home Health Agencies and Supporting Regulations 42 CFR Parts 484 and 488

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10139				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 825

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	825	825
Annual IC Time Burden (Hours)	1,238	1,238
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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