Home Health Agency Cost Report and Supporting Regulations (CMS-1728-20)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-1728-20.Supporting_Statement_Part_A.docx	Supporting Statement A	Uploaded 2023-07-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7766	Home Health Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106	Instruction	Modified

ICR Details

OMB Control No: 0938-0022	ICR Reference No: 202307-0938-008
Status: Received in OIRA	Previous ICR Reference No: 202002-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Home Health Agency Cost Report and Supporting Regulations (CMS-1728-20)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/21/2023

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	10,944	0
Time Burden (Hours)	2,134,080	0
Cost Burden (Dollars)	0	0

---

Abstract: Form CMS-1728-20 is the form used by Home Health Agencies to report their health care costs to determine the amount of reimbursement for services furnished to Medicare beneficiaries.

---

Authorizing Statute(s): US Code: 42 USC 1395g
   Statute at Large: 18 Stat. 1815
   Statute at Large: 18 Stat. 1861
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 30309	05/11/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 47144	07/21/2023
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Home Health Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24, 413.106	CMS-1728-20	HHA Cost Report

---

ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10,944	0	0	0	805	10,139
Annual Time Burden (Hours)	2,134,080	0	0	0	156,975	1,977,105
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden and cost are due to two factors. The number of respondents increased from 10,139 in 2020 to 10,944 in 2023, which has increased the burden by 156,975 hours. The hourly rates and associated administrative/overhead costs increased based on the most recent BLS Occupational and Employment Data (May 2021) (for categories 43- 3031, bookkeeping, accounting, and audit clerks, and 13-2011, accounting and auditing clerks). This resulted in an increased cost per respondent of $679 (from $9,838 per respondent in 2020 to $10,517 per respondent in 2023).

---

Annual Cost to Federal Government: $6,999,471

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/21/2023

---