Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Home Health Agency Survey and Deficiencies Report, Home Health Functional Assessment Instrument and Supporting Regulations in 42 CFR 488.26 and 442.30 Modified 8745 4373 0 Form 1515a
Form 1515b
Form 1515e
Form 1515c
Form 1515d
Form 1515F
Form 1572(a-e)
Total burden requested under this ICR: 8745 4373 0  
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