Information Collection

Hospice Conditions of Participation 418.114 (d) Newly Certified Facility

IC 189585 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 418.114 (d) Newly Certified Facility	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 418.114(d)

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: 546	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	11,250	-6,462	17,712
Annual IC Time Burden (Hours)	1,125	-69,723	70,848
Annual IC Cost Burden (Dollars)	0	0	0

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