Information Collection

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

IC 43668 under ICR 200606-0938-011 · 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: 7,612	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,351,703	10,320,703	31,000
Annual IC Time Burden (Hours)	780,918	777,818	3,100
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.