INFORMATION COLLECTION REQUIREMENTS IN THE HOSPICE CARE REGULATION

ICR 199103-0938-009

OMB: 0938-0302

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0302 199103-0938-009
Historical Active 198712-0938-001
HHS/CMS
INFORMATION COLLECTION REQUIREMENTS IN THE HOSPICE CARE REGULATION
Revision of a currently approved collection   No
Regular
Approved without change 06/03/1991
Retrieve Notice of Action (NOA) 03/04/1991
Approved for use through 12/91 under the condition that the next package submitted for OMB review includes milestones for amending the hospice and home health agency conditions of participation to make their information collection requirements mor consistent and to begin streamlining the survey processes to the maxim extent possible under the Social Security Act.
  Inventory as of this Action Requested Previously Approved
12/31/1991 12/31/1991 02/28/1991
400 0 400
466,300 0 466,300
0 0 0

THESE INFORMATION COLLECTIONS ARE NEEDED TO IMPLEMENT THE MEDICARE HOSPICE BENEFIT. INFORMATION IS NEEDED FROM INDIVIDUALS ELECTING HOSPICE CARE AND FROM HOSPICES PARTICIPATING IN THE PROGRAM TO ASSURE THAT STATUTORY AND REGULATORY REQUIREMENTS ARE MET.

None
None


No

1
IC Title Form No. Form Name
INFORMATION COLLECTION REQUIREMENTS IN THE HOSPICE CARE REGULATION HCFA-R-30

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 400 400 0 0 0 0
Annual Time Burden (Hours) 466,300 466,300 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/04/1991


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