Acute Hospital Care at Home

Submissions of 1135 Waiver Request Automated Process (CMS-10752)

OMB: 0938-1384

IC ID: 245795

Information Collection (IC) Details

View Information Collection (IC)

Acute Hospital Care at Home
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10752 Acute Hospital at Home Acute Hospital Care at Home Screenshots.docx Yes Yes Fillable Fileable

Health Health Care Services

 

290 0
   
Private Sector 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 290 0 0 0 0 290
Annual IC Time Burden (Hours) 1,899 0 0 0 0 1,899
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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