Information Collection

Hospice Conditions of Participation 418.110(n)(11) and (n)(15)

IC 189581 under ICR 202508-0938-020 · OMB 0938-1067.

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Information Collection (IC) Details

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IC Title:	Hospice Conditions of Participation 418.110(n)(11) and (n)(15)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 418.110 (n)(11) and (n)(15)

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: 1,447	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,447	314	1,133
Annual IC Time Burden (Hours)	1,085	-3,447	4,532
Annual IC Cost Burden (Dollars)	0	0	0

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