Information Collection Request
Home Health Agency Survey and Deficiencies Report and Supporting Regulations (CMS-1572)
ICR 202301-0938-012 · OMB 0938-0355 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-1572 Home Health Agency Survey and Deficiencies Report |
Form and Instruction | Modified | Repair queued |
 CMS-1572 Supporting Statement A. 01.26.23.docx |
Supporting Statement A | Uploaded 2023-01-27 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 7990 |  Home Health Agency Survey and Deficiencies Report |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0355 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202102-0938-001 |
| Agency Tracking No | 20516 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |