Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

Hospice Facility Cost Report (CMS-1984-14)

Documents and Forms

Document Name Document Type
2024 PRA-Hospice - r6P243i.pdf Instruction
2024 PRA-Hospice - r6P243i.pdf Instruction
1984-14 Hospice Facility Cost Report 2024 PRA-Hospice - r6P243f (1) (2).xlsx Form
1984-14 Hospice Facility Cost Report 2024 PRA-Hospice - r6P243f (1) (2).xlsx Form

Information Collection (IC) Details

IC Title:	Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.24 42 CFR 413.20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			2024 PRA-Hospice - r6P243i.pdf		Yes	Yes	Fillable Fileable
Form	1984-14	Hospice Facility Cost Report	2024 PRA-Hospice - r6P243f (1) (2).xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,430	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: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,430	2,051	4,379
Annual IC Time Burden (Hours)	1,208,840	385,588	823,252
Annual IC Cost Burden (Dollars)	0	0	0

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.