Information Collection

Home Health Advance Beneficiary Notices and Supporting Regulations in 42 CFR, Section 411.404 and 484.10(a) and (e)

IC 8544 under ICR 200512-0938-010 · OMB 0938-0781.

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Information Collection (IC) Details

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IC Title:	Home Health Advance Beneficiary Notices and Supporting Regulations in 42 CFR, Section 411.404 and 484.10(a) and (e)	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	CMS-R-296				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,928	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	31,000	-114,966	145,966
Annual IC Time Burden (Hours)	3,100	-11,497	14,597
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.