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HH Demo Fax and Electronic Submissions and Resubmissions (16 States)
Pre-Claim Review Demonstration For Home Health Services (CMS-10599)
OMB: 0938-1311
IC ID: 222824
OMB.report
HHS/CMS
OMB 0938-1311
ICR 202509-0938-019
IC 222824
( )
Documents and Forms
Document Name
Document Type
Form CMS-10599
HH Demo Fax and Electronic Submissions and Resubmissions (16 States)
Form
CMS-10599 Home Health Instrument
CMS-10599 - Home Health Instrument (1).pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HH Demo Fax and Electronic Submissions and Resubmissions (16 States)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-10599
Home Health Instrument
CMS-10599 - Home Health Instrument (1).pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,700
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
95 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,538,413
0
390,178
0
0
2,148,235
Annual IC Time Burden (Hours)
1,269,207
0
195,102
0
0
1,074,105
Annual IC Cost Burden (Dollars)
56,200,463
0
56,200,463
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
