Information Collection

Hospice Conditions of Participation 418.58(a)(2) Organize QAPI Data

IC 211892 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 418.58(a)(2) Organize QAPI Data	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 418.58(a)(2)

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: 7,356	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 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	7,356	2,883	4,473
Annual IC Time Burden (Hours)	353,088	339,669	13,419
Annual IC Cost Burden (Dollars)	0	0	0

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