Information Collection Request

Hospice Conditions of Participation (CMS-10277)

ICR 201406-0938-002 · OMB 0938-1067 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Hospice PRA 2013 CMS-10277 Supporting_Statement_Part_A 5-7-14 Final - 508 Compliant 06.04.14.pdf Supporting Statement A Uploaded 2014-06-04 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
211892 Hospice Conditions of Participation 418.58 Phase 3 New
211891 Hospice Conditions of Participation 418.58 Phase 2 aggregate/data analysis New
211890 Hospice Condition of Participation 418.58 Phase 2 data entry New
211889 Hospice Conditions of Participation 418.58 Phase 1 New
211888 Hospice Conditions of Participation 418.108(c)(1) New
211887 Hospice Conditions of Participation 418.110(m) New
211886 Hospice Conditions of Participation 418.100(e) New
211885 Hospice Conditions of Participation 418.52(b) New
211884 Hospice Condtions of Participation 418.52(a) New
211883 Hospice Conditions of Participation 418.28 develop revocation form New
211882 Hospice Conditions of Participation 418.24 explain election form New
211881 Hospice Conditions of Participation 418.28 explain revocation form New
211880 Hospice Conditons of Participation 418.24 develop election form New
195470 Hospice Conditions of Participation 418.22(b)(4) Modified
195469 Hospice Condition of Participation (418.22(b)(4) and (b)(5) Modified
195468 Hospice Conditions of Participation 418.22(b)(3) Modified
189585 Hospice Conditions of Participation 418.114 (b) Modified
189584 Hospice Conditions of Participation 418.114 (d) Modified
189583 Hospice Conditions of Participation 418.112(e)(3) Modified
189582 Hospice Conditions of Participation (418.110 (n) new hospice program Modified
189581 Hospice Conditions of Participation 418.110(n) training Modified
189580 Hospice Conditions of Participation 418.106(a) and (e) Modified
189579 Hospice Conditions of Participation 418.78(a)(c)(d) and (e) Modified
189578 Hospice Conditions of Participation 418.76(b)(c) and (d) Modified
189577 Hospice Conditions of Participation 418.56(b) and (c) Modified
189576 Hospice Conditions of Participation (418.52(a)(3) Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2017 36 Months From Approved
19,284,489 0 0
3,242,280 0 0
0 0 0





Reginfo record details
26
table that charts list of burden
IC Title Form No. Form Name
Hospice Conditions of Participation 418.100(e)
Hospice Conditions of Participation 418.110(m)
Hospice Conditions of Participation 418.58 Phase 1
Hospice Condition of Participation 418.58 Phase 2 data entry
Hospice Conditions of Participation (418.52(a)(3)
Hospice Conditions of Participation 418.56(b) and (c)
Hospice Conditions of Participation 418.76(b)(c) and (d)
Hospice Conditions of Participation 418.78(a)(c)(d) and (e)
Hospice Conditions of Participation 418.106(a) and (e)
Hospice Conditions of Participation 418.110(n) training
Hospice Conditions of Participation (418.110 (n) new hospice program
Hospice Conditions of Participation 418.112(e)(3)
Hospice Conditions of Participation 418.114 (d)
Hospice Conditions of Participation 418.114 (b)
Hospice Conditions of Participation 418.22(b)(3)
Hospice Condition of Participation (418.22(b)(4) and (b)(5)
Hospice Conditions of Participation 418.22(b)(4)
Hospice Condtions of Participation 418.52(a)
Hospice Conditons of Participation 418.24 develop election form
Hospice Conditions of Participation 418.108(c)(1)
Hospice Conditions of Participation 418.58 Phase 2 aggregate/data analysis
Hospice Conditions of Participation 418.58 Phase 3
Hospice Conditions of Participation 418.28 explain revocation form
Hospice Conditions of Participation 418.24 explain election form
Hospice Conditions of Participation 418.28 develop revocation form
Hospice Conditions of Participation 418.52(b)

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 19,284,489 0 0 17,061,295 0 2,223,194
Annual Time Burden (Hours) 3,242,280 0 0 1,882,066 0 1,360,214
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No