HH Demo Fax and Electronic Submissions and Resubmissions (Michigan and Massachusetts)

Pre-Claim Review Demonstration For Home Health Services (CMS-10599)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1311 can be found here:

Documents and Forms

Document Name Document Type
PCRD_HH_Operational_Guide.pdf Instruction

Information Collection (IC) Details

IC Title:	HH Demo Fax and Electronic Submissions and Resubmissions (Michigan and Massachusetts)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			PCRD_HH_Operational_Guide.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 795	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: 95 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	414,708	414,708
Annual IC Time Burden (Hours)	207,354	207,354
Annual IC Cost Burden (Dollars)	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.