View Information Collection (IC)

View Information Collection (IC)

HH Demo for Mailed Requests (16 States)
No Modified

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-10599 - Home Health Instrument.pdf Yes No Printable Only

Health Health Care Services


4,864 0
Private Sector Businesses or other for-profits, Not-for-profit institutions
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 535,040 0 0 -195,699 730,739 0
Annual IC Time Burden (Hours) 268,527 0 1 -96,844 365,370 0
Annual IC Cost Burden (Dollars) 2,675,200 0 0 -978,495 3,653,695 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.