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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.