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

Hospice FacilityCost Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0758 can be found here:

Documents and Forms

Document Name Document Type
R4P243i Hospice Facility Cost Report.pdf Instruction
R4P243i Hospice Facility Cost Report.pdf Instruction
CMS-1984-14 Hospice Facility Cost Report R4P243f Form CMS-1984-14.pdf Form
CMS-1984-14 Hospice Facility Cost Report R4P243f Form CMS-1984-14.pdf Form

Information Collection (IC) Details

IC Title:	Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24	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

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,379	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: 100 %

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