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 5614 9825 0 Form CMS-1515A
Form CMS-1515B
Form CMS-1515C
Form CMS-1515D
Form CMS-1515E
Form CMS-1515F
Form CMS-1572
Total burden requested under this ICR: 5614 9825 0  
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