View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0379	ICR Reference No: 198707-0938-007
Status: Historical Active	Previous ICR Reference No: 198408-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: HOSPICE SURVEY REPORT FORM
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/22/1987
	Date Received in OIRA: 07/28/1987
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/1988	10/31/1988	09/30/1987
Responses	50	0	53
Time Burden (Hours)	1,500	0	1,200
Cost Burden (Dollars)	0	0	0

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