Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Hospice Condition of Participation (418.22(b)(4) Unchanged 275329 2156 0
Hospice Condition of Participation 418.58(a)(2) Collect and record data Unchanged 7356 235392 0
Hospice Conditions of Participation (418.110 (o)(2) newly certified facilities Unchanged 546 21840 0
Hospice Conditions of Participation (418.52(a)(3) Unchanged 7356 147120 0
Hospice Conditions of Participation 418.106 (e)(2)(i)(C) Unchanged 7356 147120 0
Hospice Conditions of Participation 418.108(c)(1) Unchanged 7356 47814 0
Hospice Conditions of Participation 418.108(c)(3) Unchanged 7356 23539 0
Hospice Conditions of Participation 418.110 (o)(4) Unchanged 7356 7356 0
Hospice Conditions of Participation 418.110(n)(11) and (n)(15) Unchanged 1447 1085 0
Hospice Conditions of Participation 418.112(e)(3) Unchanged 7356 88272 0
Hospice Conditions of Participation 418.114 (b)(3)(i)(B) Unchanged 74 3552 0
Hospice Conditions of Participation 418.114 (d) Unchanged 76052 7605 0
Hospice Conditions of Participation 418.114 (d) Newly Certified Facility Unchanged 11250 1125 0
Hospice Conditions of Participation 418.22(b) Certification Form Development Modified 546 546 0
Hospice Conditions of Participation 418.22(b)(3) Modified 2957691 243732 0
Hospice Conditions of Participation 418.22(b)(5) Unchanged 2957691 23662 0
Hospice Conditions of Participation 418.24(b) explain election statement Unchanged 1516946 378426 0
Hospice Conditions of Participation 418.28(d) develop revocation form Unchanged 546 137 0
Hospice Conditions of Participation 418.28(d) explain revocation form Unchanged 101233 8338 0
Hospice Conditions of Participation 418.52(b)(4) Unchanged 7356 88272 0
Hospice Conditions of Participation 418.56(b) Unchanged 7356 882720 0
Hospice Conditions of Participation 418.56(c) Unchanged 7356 294240 0
Hospice Conditions of Participation 418.58 (a)(2) Document Analysis Unchanged 7356 294240 0
Hospice Conditions of Participation 418.58(a)(2) Develop QAPI program Unchanged 546 6552 0
Hospice Conditions of Participation 418.58(a)(2) ID new measures Unchanged 7356 110340 0
Hospice Conditions of Participation 418.58(a)(2) Organize QAPI Data Unchanged 7356 353088 0
Hospice Conditions of Participation 418.76(b)(4) Existing Facilities Unchanged 7356 611 0
Hospice Conditions of Participation 418.76(b)(4) Newly certified Facilities Unchanged 546 227 0
Hospice Conditions of Participation 418.76(d)(2) Unchanged 7356 14712 0
Hospice Conditions of Participation 418.78(a)(c)(d) and (e) Unchanged 29424 400902 0
Hospice Conditons of Participation 418.24 develop election form Unchanged 546 546 0
Hospice Condtions of Participation 418.52(a)(1) Unchanged 546 4368 0
§418.24(c) Addendum Form Development Unchanged 546 274 0
§418.24(c) Addendum Form Completion Modified 1517250 255816 0
Total burden requested under this ICR: 9559095 4095725 0  
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