OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies (HHA) (CMS-10539)

OMB 0938-1299 · HHS/CMS.

OMB 0938-1299

Home health agencies are required to maintain certain documentation within their own agency records that demonstrates compliance with specific Conditions of Participation for the Medicare program. This documentation is maintained on-site for use in the home health agency survey process.

The latest form for Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies (HHA) (CMS-10539) expires 2029-06-30 and is listed under ICR 202509-0938-018.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
CMS-10539 - Attachment A - 60-day comment.docxPublic Comments
CMS-10539 - Attachment A - Response to 60-day comment.docx (document unavailable)Public Comments
CMS-10539 - Attachment A - Response to 60-day comment.docxSupplementary Document
CMS-10539 - Supporting Statement.docxSupporting Statement A
484.65(b)&(c) Information collection
484.105(i)(2) Information collection
484.58(b)(1) and (2) Information collection
484.70 Information collection
484.65(d) Information collection
484.60(e) Information collection
484.60(c) Information collection
484.60(a) Information collection
484.110(a) - content of clinical records Information collection
484.105(i)(1) Information collection
484.105(h) - existing Information collection
484.100(a) - new agencies Information collection
484.80(d) - in-service training Information collection
484.80(b) - home health aide classroom and practical training Information collection
484.80(c) - compentency evaluation Information collection
484.80(a) Information collection
484.65(a)(d) and (e) - quality assessment and performance Information collection
484.60(a) care planning Information collection
484.50(e) Information collection
484.50(a) new agencies Information collection

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202509-0938-018 Reinstatement with change of a previously approved collection 2025-09-24
202101-0938-006 Revision of a currently approved collection 2021-01-19 Approved without change
201712-0938-006 Existing collection in use without an OMB Control Number 2017-12-08 Approved with change
201701-0938-006 New collection (Request for a new OMB Control Number) 2017-01-25 Withdrawn
201507-0938-005 New collection (Request for a new OMB Control Number) 2015-07-10 Comment filed on proposed rule

OMB Details

484.50(a) new agencies

Federal Enterprise Architecture: Health - Health Care Services