Information Collection Request

Hospice Conditions of Participation (CMS-10277)

ICR 202604-0938-016 · OMB 0938-1067 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-10277-Supporting Statement.docx Supporting Statement A Uploaded 2026-04-21 Repair queued
CMS-10277-Supporting Statement.docx Supporting Statement A Uploaded 2026-04-21 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
277315 Hospice Conditions of Participation 418.22(b) Certification Form Development Modified
277314 Hospice Conditions of Participation 418.58(a)(2) ID new measures Unchanged
277295 Hospice Conditions of Participation 418.114 (b)(3)(i)(B) Unchanged
277282 Hospice Conditions of Participation 418.110 (o)(4) Unchanged
277280 Hospice Conditions of Participation 418.76(b)(4) Newly certified Facilities Unchanged
277279 Hospice Conditions of Participation 418.76(b)(4) Existing Facilities Unchanged
277277 Hospice Conditions of Participation 418.56(c) Unchanged
241790 §418.24(c) Addendum Form Development Unchanged
241789 §418.24(c) Addendum Form Completion Modified
230612 Hospice Conditions of Participation 418.108(c)(3) Unchanged
211892 Hospice Conditions of Participation 418.58(a)(2) Organize QAPI Data Unchanged
211891 Hospice Conditions of Participation 418.58 (a)(2) Document Analysis Unchanged
211890 Hospice Condition of Participation 418.58(a)(2) Collect and record data Unchanged
211889 Hospice Conditions of Participation 418.58(a)(2) Develop QAPI program Unchanged
211888 Hospice Conditions of Participation 418.108(c)(1) Unchanged
211885 Hospice Conditions of Participation 418.52(b)(4) Unchanged
211884 Hospice Condtions of Participation 418.52(a)(1) Unchanged
211883 Hospice Conditions of Participation 418.28(d) develop revocation form Unchanged
211882 Hospice Conditions of Participation 418.24(b) explain election statement Unchanged
211881 Hospice Conditions of Participation 418.28(d) explain revocation form Unchanged
211880 Hospice Conditons of Participation 418.24 develop election form Unchanged
195470 Hospice Conditions of Participation 418.22(b)(5) Unchanged
195469 Hospice Condition of Participation (418.22(b)(4) Unchanged
195468 Hospice Conditions of Participation 418.22(b)(3) Modified
189585 Hospice Conditions of Participation 418.114 (d) Newly Certified Facility Unchanged
189584 Hospice Conditions of Participation 418.114 (d) Unchanged
189583 Hospice Conditions of Participation 418.112(e)(3) Unchanged
189582 Hospice Conditions of Participation (418.110 (o)(2) newly certified facilities Unchanged
189581 Hospice Conditions of Participation 418.110(n)(11) and (n)(15) Unchanged
189580 Hospice Conditions of Participation 418.106 (e)(2)(i)(C) Unchanged
189579 Hospice Conditions of Participation 418.78(a)(c)(d) and (e) Unchanged
189578 Hospice Conditions of Participation 418.76(d)(2) Unchanged
189577 Hospice Conditions of Participation 418.56(b) Unchanged
189576 Hospice Conditions of Participation (418.52(a)(3) Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2029 36 Months From Approved 02/28/2029
9,209,893 0 9,209,893
4,032,329 0 4,032,329
0 0 0





Reginfo record details
34
table that charts list of burden
IC Title Form No. Form Name
Hospice Condition of Participation (418.22(b)(4)
Hospice Condition of Participation 418.58(a)(2) Collect and record data
Hospice Conditions of Participation (418.110 (o)(2) newly certified facilities
Hospice Conditions of Participation (418.52(a)(3)
Hospice Conditions of Participation 418.106 (e)(2)(i)(C)
Hospice Conditions of Participation 418.108(c)(1)
Hospice Conditions of Participation 418.108(c)(3)
Hospice Conditions of Participation 418.110 (o)(4)
Hospice Conditions of Participation 418.110(n)(11) and (n)(15)
Hospice Conditions of Participation 418.112(e)(3)
Hospice Conditions of Participation 418.114 (b)(3)(i)(B)
Hospice Conditions of Participation 418.114 (d)
Hospice Conditions of Participation 418.114 (d) Newly Certified Facility
Hospice Conditions of Participation 418.22(b) Certification Form Development
Hospice Conditions of Participation 418.22(b)(3)
Hospice Conditions of Participation 418.22(b)(5)
Hospice Conditions of Participation 418.24(b) explain election statement
Hospice Conditions of Participation 418.28(d) develop revocation form
Hospice Conditions of Participation 418.28(d) explain revocation form
Hospice Conditions of Participation 418.52(b)(4)
Hospice Conditions of Participation 418.56(b)
Hospice Conditions of Participation 418.56(c)
Hospice Conditions of Participation 418.58 (a)(2) Document Analysis
Hospice Conditions of Participation 418.58(a)(2) Develop QAPI program
Hospice Conditions of Participation 418.58(a)(2) ID new measures
Hospice Conditions of Participation 418.58(a)(2) Organize QAPI Data
Hospice Conditions of Participation 418.76(b)(4) Existing Facilities
Hospice Conditions of Participation 418.76(b)(4) Newly certified Facilities
Hospice Conditions of Participation 418.76(d)(2)
Hospice Conditions of Participation 418.78(a)(c)(d) and (e)
Hospice Conditons of Participation 418.24 develop election form
Hospice Condtions of Participation 418.52(a)(1)
§418.24(c) Addendum Form Development
§418.24(c) Addendum Form Completion



Reginfo record details
  No