HH Demo for Mailed Requests (16 States)

Pre-Claim Review Demonstration For Home Health Services (CMS-10599)

Documents and Forms

Document Name Document Type
CMS-10599 - Home Health Instrument.pdf Instruction
CMS-10599 - Home Health Instrument.pdf Instruction

Information Collection (IC) Details

IC Title:	HH Demo for Mailed Requests (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: 4,864	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: 0 %

	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	535,040	0	-195,699	730,739
Annual IC Time Burden (Hours)	268,527	1	-96,844	365,370
Annual IC Cost Burden (Dollars)	2,675,200	0	-978,495	3,653,695

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.