Home Health Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0022 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-1728-94 Home Health Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106 Form
pr2_32_toc.docx Instruction
pr2_3200_to_3215.2.docx Instruction
pr2_3215.3_to_3238.docx Instruction
pr2_3215.3_to_3246.docx Instruction
pr2_3290_exhibit_1.docx Instruction
pr2_3295.docx Instruction
CMS-1728-94 Medicare Cost Report Forms R15P232f.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Home Health Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106	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 42 CFR 413.106

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-1728-94	Medicare Cost Report Forms	R15P232f.xlsx	Yes	Yes	Fillable Printable
Instruction			pr2_32_toc.docx	Yes	Yes	Printable Only
Instruction			pr2_3200_to_3215.2.docx	Yes	Yes	Printable Only
Instruction			pr2_3215.3_to_3238.docx	Yes	Yes	Printable Only
Instruction			pr2_3215.3_to_3246.docx	Yes	Yes	Printable Only
Instruction			pr2_3290_exhibit_1.docx	Yes	Yes	Printable Only
Instruction			pr2_3295.docx	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,479	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: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,479	2,410	5,069
Annual IC Time Burden (Hours)	1,690,254	798,110	892,144
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.