(CMS-1572) Home Health Agency Survey and Deficiencies Report and Supporting Regulations
Reinstatement with change of a previously approved collection
No
Regular
02/04/2021
Requested
Previously Approved
36 Months From Approved
3,833
0
1,917
0
0
0
In order to participate in the Medicare program as a Home Health Agency (HHA) provider, the HHA must meet Federal standards. The survey forms summarize data relative to provider characteristics, the patient population, and special needs of the patient populations. These forms are used to record information about patientsâ health and provider compliance with requirements and report information to the Federal Government.
US Code:
42 USC 442.30
Name of Law: Agreement as Evidence of Certification
US Code:
42 USC 488.26
Name of Law: Determining Compliance
In the previous PRA package submission, the approved time burden was 849 hours and the approved cost burden was $86,598. In this current PRA package, we are requesting approval for a total time burden of 1,917 hours and a total cost burden of $142,778. This is an increase in the time burden of 1,068 hours and an increase in the cost burden of $56,180. This increase in the time and cost burden in due to the recalculation and correction of the existing burden, which had previously been incorrectly calculated.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-1572 Home Health Agency Survey and Deficiencies Report
CMS-1572 Supporting Statement A. 02.02.21.docx
Home Health Agency Survey and Deficiencies Report