HEALTH INSURANCE STUDY, MEDICAL HISTORY, FORM A

ICR 197508-0990-001

OMB: 0990-0005

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
116488 Migrated
ICR Details
0990-0005 197508-0990-001
Historical Active
HHS/HHSDM
HEALTH INSURANCE STUDY, MEDICAL HISTORY, FORM A
Revision of a currently approved collection   No
Regular
Approved without change 10/01/1975
Retrieve Notice of Action (NOA) 08/27/1975
  Inventory as of this Action Requested Previously Approved
12/31/1980 12/31/1980
5,400 0 0
5,400 0 0
0 0 0

THIS STUDY IS DESIGNED TO MEASURE THE EFFECTS OF ALTERNATIVE HEALTH INSURANCE PLANS ON THE DEMAND FOR AND QUALITY OF HEALTH CARE, AND HEALTH STATUS. THE RESULTS WILL PROVIDE AN IMPORTANT DATA BASE FOR ANALYTIC PLANNING FOR NATIONAL HEALTH INSURANCE AND WILL ALSO BE USEFUL IN ASSESSMENT OF ALTERNATIVE MANPOWER POLICIES.

None
None


No

1
IC Title Form No. Form Name
HEALTH INSURANCE STUDY, MEDICAL HISTORY, FORM A OS-48-75-C

  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 5,400 0 0 0 5,400 0
Annual Time Burden (Hours) 5,400 0 0 0 5,400 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.
08/27/1975


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