Information Collection

Hospice Condition of Participation (418.22(b)(4) and (b)(5)

IC 195469 under ICR 201809-0938-005 · OMB 0938-1067.

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Information Collection (IC) Details

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IC Title:	Hospice Condition of Participation (418.22(b)(4) and (b)(5)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 418.22(b)(4) and (b)(5)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,362	Number of Respondents for Small Entity: 3,727

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	3,143,155	3,143,155
Annual IC Time Burden (Hours)	26,192	26,192
Annual IC Cost Burden (Dollars)	0	0

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