REQUEST FOR CLAIM NUMBER VERIFICATION

ICR 197501-0938-003

OMB: 0938-0089

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
112838 Migrated
ICR Details
0938-0089 197501-0938-003
Historical Active
HHS/CMS
REQUEST FOR CLAIM NUMBER VERIFICATION
Extension without change of a currently approved collection   No
Regular
Approved without change 02/19/1975
Retrieve Notice of Action (NOA) 01/31/1975
  Inventory as of this Action Requested Previously Approved
04/30/1980 04/30/1980
400,000 0 0
32,000 0 0
0 0 0



None
None


No

1
IC Title Form No. Form Name
REQUEST FOR CLAIM NUMBER VERIFICATION SSA-1600

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 400,000 0 0 0 400,000 0
Annual Time Burden (Hours) 32,000 0 0 0 32,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
01/31/1975


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