Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

Hospice FacilityCost Report

OMB: 0938-0758

IC ID: 8476

Information Collection (IC) Details

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Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24
 
No Modified
 
Mandatory
 
42 CFR 413.20 42 CFR 413.24

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction R4P243i Hospice Facility Cost Report.pdf No   Printable Only
Form CMS-1984-14 Hospice Facility Cost Report R4P243f Form CMS-1984-14.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

4,379 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,379 0 0 834 3,545 0
Annual IC Time Burden (Hours) 823,252 0 0 156,792 666,460 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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