Information Collection

Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

IC 8476 under ICR 200711-0938-003 · OMB 0938-0758.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0758 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
pr2_38_toc.doc	Other-Manual
pr2_3800_3890.doc	Instruction
R7P238f.XLS	Other-Form
R7P238s.XLS	Other-Reporting Specifications

IC Title:

Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.24 42 CFR 413.20

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Manual	pr2_38_toc.doc	Yes	Yes	Paper Only
Instruction	pr2_3800_3890.doc	Yes	Yes	Paper Only
Other-Form	R7P238f.XLS	No	No	Paper Only
Other-Reporting Specifications	R7P238s.XLS	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,938

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,938	218	1,720
Annual IC Time Burden (Hours)	341,088	38,368	302,720
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.