Face-to-Face encounter, form development (424.22 first year)-One Time Form Revision

Medicare Program/Home Health Prospective Payment System Rate Update for CY2010: Physician Narrative Requirement, CY2011 Final Physician Face-to-Face Encounter

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1083 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Face-to-Face encounter, form development (424.22 first year)-One Time Form Revision	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 424.22(a)(1)(v)

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: 11,327	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: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	11,327	1,895	9,432
Annual IC Time Burden (Hours)	5,664	948	4,716
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.