View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-0379	ICR Reference No: 199704-0938-001
Status: Historical Active	Previous ICR Reference No: 199403-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hospice Survey and Deficiencies Report Form and Supporting Regulations -- 42 CFR 488, 488.26(c), 442.30(a)(4), 442 subparts B, C, D, E, and F
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: 07/09/1997
	Date Received in OIRA: 04/08/1997
Terms of Clearance: Approved for use through 7/2000 under the condition that HCFA immediately incorporates the new disclosure statements mandated by the Paperwork Reduction Act of 1995. For the public record, HCFA must submit to OMB the revised forms/instructions.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2000	08/31/2000	07/31/1997
Responses	2,150	0	1,400
Time Burden (Hours)	5,375	0	3,500
Cost Burden (Dollars)	0	0	0

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