Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24 (CMS-R-249)

Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0758 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-R-249 Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24 (CMS-R-249) Form
Hospice MCR Instructions.doc Instruction
CMS-R-249 Hospice Medicare Cost Report Forms Hospice MCR Forms.XLS Form
Hospice ECR Specs.XLS Hospice ECR Specs IC Document

Information Collection (IC) Details

IC Title:	Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24 (CMS-R-249)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.24 42 CFR 413.20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-249	Hospice Medicare Cost Report Forms	Hospice MCR Forms.XLS		Yes	Yes	Fillable Fileable
Instruction			Hospice MCR Instructions.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,303	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,303	365	1,938
Annual IC Time Burden (Hours)	405,328	64,240	341,088
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Hospice ECR Specs	Hospice ECR Specs.XLS	10/19/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.