Information Collection

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

IC 8476 under ICR 201011-0938-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-R-249 Hospice Medicare Cost Report Forms Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24 (CMS-R-249)	Form
Hospice MCR Instructions.doc	Instruction
CMS-R-249 Hospice Medicare Cost Report Forms Hospice MCR Forms.XLS	Form
Hospice ECR Specs.XLS Hospice ECR Specs	IC Document

IC Title:

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

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-249				Yes	Yes	Fillable Fileable
Instruction					Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,303

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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,303	365	1,938
Annual IC Time Burden (Hours)	405,328	64,240	341,088
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Hospice ECR Specs		10/19/2010

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

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