Hospice Facility Cost Report (CMS-1984-14)

OMB 0938-0758

The Hospice Cost and Data Report provides for the collection of data from providers for rate evaluations for the Prospective Payment System (PPS). The data is used by CMS to update the PPS as mandated by Congress.

The latest form for Hospice Facility Cost Report (CMS-1984-14) expires 2021-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS 1984-14 PRA-Hospice - Supporting Statement A.docx Supporting Statement A
Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24 Instruction

All Historical Document Collections

202409-0938-024	Extension without change of a currently approved collection	2024-10-02
202106-0938-004 Approved without change	Reinstatement with change of a previously approved collection	2021-06-10
201707-0938-014 Approved with change	Reinstatement without change of a previously approved collection	2017-08-02
201312-0938-003 Approved without change	Revision of a currently approved collection	2013-12-06
201011-0938-002 Approved without change	Extension without change of a currently approved collection	2010-11-02
200711-0938-003 Approved without change	Extension without change of a currently approved collection	2007-11-15
200411-0938-008 Approved without change	Extension without change of a currently approved collection	2004-11-30
200201-0938-008 Approved without change	Extension without change of a currently approved collection	2002-01-31
199901-0938-006 Approved without change	New collection (Request for a new OMB Control Number)	1999-01-15