Information Collection

HH Demo Fax and Electronic Submissions and Resubmissions (16 States)

IC 222824 under ICR 202509-0938-019 · OMB 0938-1311.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1311 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10599 HH Demo Fax and Electronic Submissions and Resubmissions (16 States)	Form
Form CMS-10599 Home Health Instrument HH Demo Fax and Electronic Submissions and Resubmissions (16 States)	Form
CMS-10599 Home Health Instrument CMS-10599 - Home Health Instrument (1).pdf	Form
CMS-10599 Home Health Instrument CMS-10599 - Home Health Instrument (1).pdf	Form

IC Title:

HH Demo Fax and Electronic Submissions and Resubmissions (16 States)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	CMS-10599				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,700

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: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,538,413	390,178	2,148,235
Annual IC Time Burden (Hours)	1,269,207	195,102	1,074,105
Annual IC Cost Burden (Dollars)	56,200,463	56,200,463	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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