Home Health Advance Beneficiary Notices and Supporting Regulations in 42 CFR, Section 411.4304 and 484.10(a) and (e)

ICR 200505-0938-001

OMB: 0938-0781

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0781 200505-0938-001
Historical Active 200204-0938-002
HHS/CMS
Home Health Advance Beneficiary Notices and Supporting Regulations in 42 CFR, Section 411.4304 and 484.10(a) and (e)
Revision of a currently approved collection   No
Emergency 06/06/2005
Approved with change 09/21/2005
Retrieve Notice of Action (NOA) 05/02/2005
This information collection is approved until 12/31/05. The agency will resubmit a new information collection request which revises these requirements in accordance with the Lutwin v. Thompson decision and takes into account public comments.
  Inventory as of this Action Requested Previously Approved
12/31/2005 12/31/2005 09/30/2005
145,966 0 145,966
14,597 0 14,597
0 0 0

Home Health Agencies must provide proper written notice to Medicare beneficiaries in advance of furnishing home health care that they believe Medicare will not pay befor reducing terminating or denying services to a Medicare beneficiary.

None
None


No

1
IC Title Form No. Form Name
Home Health Advance Beneficiary Notices and Supporting Regulations in 42 CFR, Section 411.4304 and 484.10(a) and (e) CMS-R-296

  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 145,966 145,966 0 0 0 0
Annual Time Burden (Hours) 14,597 14,597 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.
05/02/2005


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