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

ICR 200606-0938-011

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 200606-0938-011
Historical Active 200512-0938-010
HHS/CMS
Home Health Advance Beneficiary Notices and Supporting Regulations in 42 CFR, Section 411.404 and 484.10(a) and (e)
Revision of a currently approved collection   No
Regular
Approved without change 08/02/2006
Retrieve Notice of Action (NOA) 06/21/2006
  Inventory as of this Action Requested Previously Approved
08/31/2009 36 Months From Approved 08/31/2006
10,351,703 0 31,000
780,918 0 3,100
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 before 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 411.404 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 10,351,703 31,000 0 0 10,320,703 0
Annual Time Burden (Hours) 780,918 3,100 0 0 777,818 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.
06/21/2006


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