Information Collection

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

IC 8476 under ICR 202409-0938-024 · OMB 0938-0758.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1984-14 Hospice Facility Cost Report Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24	Form
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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					Yes	Yes	Fillable Fileable
Form	1984-14				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 %

table that charts list of burden
	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

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.

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