HH Demo Fax and Electronic Submissions and Resubmissions (16 States)

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⚠️ Notice: This information collection may be referencing outdated material.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
CMS-10599 - Home Health Instrument.pdf Instruction

Information Collection (IC) Details

IC Title:	HH Demo Fax and Electronic Submissions and Resubmissions (16 States)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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			CMS-10599 - Home Health Instrument.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,221	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,461,477	1,046,769	414,708
Annual IC Time Burden (Hours)	730,739	523,385	207,354
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.