Hospice Survey and Deficiencies Report Form

Hospice Survey and Deficiencies Report Form

OMB: 0938-0379

IC ID: 8022

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Hospice Survey and Deficiencies Report Form
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-643 No No


    

2,511 0
   
Private Sector Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 490 0 0 15 0 475
Annual IC Time Burden (Hours) 1,225 0 0 -4,508 0 5,733
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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