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

Home Health Agency Cost Report and Supporting Regulations

⚠️ Notice: This information collection may be referencing outdated material.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_.doc Instruction
CMS-1728-94 Home Health Agency Cost Report Certification and Settlem R16p232f1.pdf Form

Information Collection (IC) Details

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-1728-94	Home Health Agency Cost Report Certification and Settlement Summary	R16p232f1.pdf		Yes	Yes	Fillable Printable
Instruction			pr2_32_.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11,563	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11,563	4,084	7,479
Annual IC Time Burden (Hours)	2,613,238	922,984	1,690,254
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.