Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Hospice Survey and Deficiencies Report Form and Supporting Regulations -- 42 CFR 488, 488.26(c), 442.30(a)(4), 442 subparts B, C, D, E, and F Migrated 2150 5375 0 Form HCFA-643
Total burden requested under this ICR: 2150 5375 0  
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