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Federal forms, ICRs, and supporting documents

Information Collection

Home Health Care Providers Event Form

IC 191101 under ICR 202603-0935-001 · OMB 0935-0118.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Home Health Care Providers Event Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 55 Home Healthcare for Healthcare Providers Event Form Attachment 55 -- Home Healthcare for Healthcare Providers Event Form.pdf Yes Yes Fillable Fileable
Form and Instruction 56 Home Healthcare for Non-healthcare Providers Attachment 56 -- Home Healthcare for Non-healthcare Providers.pdf Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

505 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,858 0 158 0 0 2,700
Annual IC Time Burden (Hours) 143 0 0 8 0 135
Annual IC Cost Burden (Dollars) 6,266 0 0 6,266 0 0

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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