Information Collection Request

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

ICR 201912-0938-011 · OMB 0938-1319 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-10609 - Supporting Statement A (2019 version 3).doc Supporting Statement A Uploaded 2019-12-18 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
222848 Home Health Services: Documentation of the Face-to-Face Encounter Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2023 36 Months From Approved 02/29/2020
1,143,443 0 1,143,443
190,955 0 190,955
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Home Health Services: Documentation of the Face-to-Face Encounter

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,143,443 1,143,443 0 0 0 0
Annual Time Burden (Hours) 190,955 190,955 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No