Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
(Physician) Survey of Access to Home Health Services for Medicare Beneficiaries
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Post Card
HHSC_Physician postcard text 03292012_508.pdf
No
No
Printable Only
Instruction
HHSC_Prompting script 03292012_508.pdf
No
No
Fillable Printable
Form
CMS-10429
(Physician) Survey of Access to Home Health Services for Medicare Beneficiaries
HHSC_Physician Survey [rev 6-27-2012].pdf
No
No
Fillable Printable
Other-Cover Letter
HHSC_Physician prenotice letter REVISED 11-19-2012.pdf
No
Paper Only
Other-Cover Letter
Physician cover letter REVISED 11-19-12.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
275
Number of Respondents for Small Entity:
215
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
275
275
0
0
0
0
Annual IC Time Burden (Hours)
69
69
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.