View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0379	ICR Reference No: 198909-0938-004
Status: Historical Active	Previous ICR Reference No: 198808-0938-002
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: 12/01/1989
	Date Received in OIRA: 09/12/1989
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/1992	11/30/1992	10/31/1989
Responses	560	0	450
Time Burden (Hours)	1,680	0	1,500
Cost Burden (Dollars)	0	0	0

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