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: 200307-0938-010
Status: Historical Active	Previous ICR Reference No: 200006-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hospice Survey and Deficiencies Report Form and Supporting Regulations at 42 CFR 488.26(c) and 42 CFR 442.30(a)(4)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/24/2003
	Date Received in OIRA: 07/30/2003
Terms of Clearance: This information collection request is approved for an additional three years, as modified. OMB notes that the burden reduction claimed by CMS was not supported by the information provided in the supporting statement. Should CMS wish to modify the burden, it must provide OMB with justification of this change and can do so with an 83-C.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2006	09/30/2006	09/30/2003
Responses	475	0	2,293
Time Burden (Hours)	5,733	0	5,733
Cost Burden (Dollars)	0	0	0

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.