Information Collection

Hospice Conditions of Participation 418.58 Phase 3

IC 211892 under ICR 201809-0938-005 · OMB 0938-1067.

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Information Collection (IC) Details

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IC Title:	Hospice Conditions of Participation 418.58 Phase 3	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 418.58

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: 4,473	Number of Respondents for Small Entity: 3,897

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	4,473	4,473
Annual IC Time Burden (Hours)	13,419	13,419
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.