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

Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24 (CMS-R-249)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
pr2_38_toc.doc Other-Manual
pr2_3800_3890.doc Instruction
R7P238f.XLS Other-Form
R7P238s.XLS Other-Reporting Specifications

Information Collection (IC) Details

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:

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 %

	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

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.