Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Hospice Condition of Participation (418.22(b)(4) and (b)(5) Modified 3143155 26192 0
Hospice Condition of Participation 418.58 Phase 2 data entry Modified 3185488 423340 0
Hospice Conditions of Participation (418.110 (n) new hospice training program Modified 38 1520 0
Hospice Conditions of Participation (418.52(a)(3) Modified 1592388 132699 0
Hospice Conditions of Participation 418.100(e) Modified 4473 357840 0
Hospice Conditions of Participation 418.106(a) and (e) Modified 4772303 396881 0
Hospice Conditions of Participation 418.108(c) Modified 317583 53676 0
Hospice Conditions of Participation 418.108(c)(3) New 317583 26833 0
Hospice Conditions of Participation 418.110(m) Modified 1133 850 0
Hospice Conditions of Participation 418.110(n) documentation New 18128 1511 0
Hospice Conditions of Participation 418.110(n) training Modified 1133 4532 0
Hospice Conditions of Participation 418.112(e)(3) Modified 545706 63501 0
Hospice Conditions of Participation 418.114 (b) Modified 17712 70848 0
Hospice Conditions of Participation 418.114 (d) Modified 21656 3069 0
Hospice Conditions of Participation 418.22(b) Modified 280 280 0
Hospice Conditions of Participation 418.22(b)(3) Modified 2344934 195411 0
Hospice Conditions of Participation 418.24 explain election form Modified 1236443 309111 0
Hospice Conditions of Participation 418.28 develop revocation form Modified 280 70 0
Hospice Conditions of Participation 418.28 explain revocation form Modified 80011 6668 0
Hospice Conditions of Participation 418.52(b) Modified 80514 80514 0
Hospice Conditions of Participation 418.56(b) and (c) Modified 3184776 1060101 0
Hospice Conditions of Participation 418.58 Phase 1 Modified 1120 3360 0
Hospice Conditions of Participation 418.58 Phase 2 aggregate/data analysis Modified 71568 261468 0
Hospice Conditions of Participation 418.58 Phase 3 Modified 4473 13419 0
Hospice Conditions of Participation 418.76(c) and (d) Modified 8946 9318 0
Hospice Conditions of Participation 418.78(a)(c)(d) and (e) Modified 40257 243779 0
Hospice Conditons of Participation 418.24 develop election form Modified 280 280 0
Hospice Condtions of Participation 418.52(a) Modified 285 2280 0
Total burden requested under this ICR: 20992646 3749351 0  
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