Information Collection

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

IC 222848 under ICR 201608-0938-003 · OMB 0938-1319.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Disclosure Statement.doc PRA Disclosure Statement	IC Document

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.