Information Collection

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

IC 7766 under ICR 201602-0938-002 · OMB 0938-0022.

⚠️ Notice: This information collection may be referencing outdated material.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_33.pdf Instruction
CMS-1728-94 Home Health Agency Cost Report 1728HospiceFQHC-R16p232f_AD91815.pdf 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-1728-94	Home Health Agency Cost Report	1728HospiceFQHC-R16p232f_AD91815.pdf		Yes	Yes	Fillable Printable
Instruction			pr2_33.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,717	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10,717	-846	11,563
Annual IC Time Burden (Hours)	2,432,759	-180,479	2,613,238
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.