View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0379	ICR Reference No: 200906-0938-005
Status: Historical Active	Previous ICR Reference No: 200604-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hospice Survey and Deficiencies Report Form (CMS-643)
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: 08/10/2009
	Date Received in OIRA: 06/11/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2012	36 Months From Approved	08/31/2009
Responses	1,130	0	490
Time Burden (Hours)	1,130	0	1,225
Cost Burden (Dollars)	0	0	0

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