Information Collection

Acute Hospital Care at Home

IC 245795 under ICR 202308-0938-016 · OMB 0938-1384.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1384 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10752 Acute Hospital Care at Home	Form and Instruction
CMS-10752 Acute Hospital at Home Acute Hospital Care at Home Screenshots.docx	Form and Instruction

IC Title:

Acute Hospital Care at Home

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 290

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	290	290
Annual IC Time Burden (Hours)	1,899	1,899
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.