Information Collection

Home Health Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106

IC 7766 under ICR 202002-0938-013 · OMB 0938-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0022 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-1728-20 Home Health Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106	Form
CMS-1728-20. Chapter 47 (5-20-20).docx	Instruction
CMS-1728-20 HHA Cost Report CMS-1728-20.HHA Cost Report - 5-20-20.xlsx	Form

IC Title:

Home Health Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.20 42 CFR 413.24 42 CFR 413.106

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
Form	CMS-1728-20	HHA Cost Report	CMS-1728-20.HHA Cost Report - 5-20-20.xlsx		Yes	Yes	Fillable Fileable Signable
Instruction			CMS-1728-20. Chapter 47 (5-20-20).docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,139

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	10,139	0	-578	10,717
Annual IC Time Burden (Hours)	1,977,105	-324,448	-131,206	2,432,759
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
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.