Home Health Services: Documentation of the Face-to-Face Encounter

Medicaid Program Face-to-Face Requirements for Home Health Services and Supporting Regulations under 42 CFR 440.70(f) and (g) (CMS-10609)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1319 can be found here:

Documents and Forms

Document Name Document Type
Disclosure Statement.doc PRA Disclosure Statement IC Document

Information Collection (IC) Details

IC Title:	Home Health Services: Documentation of the Face-to-Face Encounter	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 440.70(f) and (g)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,143,443	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	1,143,443	1,143,443
Annual IC Time Burden (Hours)	190,955	190,955
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PRA Disclosure Statement	Disclosure Statement.doc	08/05/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.