Information Collection

HH Demo for Mailed Requests (16 States)

IC 222825 under ICR 202509-0938-019 · OMB 0938-1311.

Documents and Forms

Document Name Document Type
CMS-10599 - Home Health Instrument.pdf Instruction
CMS-10599 - Home Health Instrument.pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HH Demo for Mailed Requests (16 States)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10599 - Home Health Instrument.pdf		Yes	No	Printable Only

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: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	634,603	99,563	535,040
Annual IC Time Burden (Hours)	317,301	48,774	268,527
Annual IC Cost Burden (Dollars)	17,223,132	14,547,932	2,675,200

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.

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