OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

(Home Health Agencies) Survey of Access to Home Health Services for Medicare Beneficiaries

IC 202896 under ICR 201206-0938-009 · OMB 0938-1183.

Documents and Forms
Document Name
Document Type
Form
Other-Cover Letter
Other-Post Card
Other-Letter
Instruction
Form
Information Collection (IC) Details

View Information Collection (IC)

(Home Health Agencies) Survey of Access to Home Health Services for Medicare Beneficiaries
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10429 (Home Health Agencies) Survey of Access to Home Health Services for Medicare Beneficiaries HHSC_HHA Survey [rev 6-27-20012].pdf No No Fillable Printable
Other-Cover Letter HHSC_HHA cover letter 03292012_508.pdf No No Printable Only
Other-Post Card HHSC_HHA postcard text 04122012_508.pdf No No Printable Only
Other-Letter HHSC_HHA prenotice letter 03292012_508.pdf No No Printable Only
Instruction HHSC_Prompting script 03292012_508.pdf No No Fillable Printable

Health Health Care Services

 

600 540
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 600 600 0 0 0 0
Annual IC Time Burden (Hours) 150 150 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.