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: 200604-0938-010
Status: Historical Active	Previous ICR Reference No: 200307-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hospice Survey and Deficiencies Report Form
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: 07/12/2006
	Date Received in OIRA: 04/26/2006
Terms of Clearance: CMS has revised the burden calculation since the last submission in accordance with the previous terms of clearance. Any addition al changes to the burden calculation can be submitted with suppor ting justification with an 83-C.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2009	07/31/2009	09/30/2006
Responses	490	0	475
Time Burden (Hours)	1,225	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.