PORTABLE X-RAY SURVEY REPORT FORM

ICR 197709-0938-005

OMB: 0938-0027

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
112553 Migrated
ICR Details
0938-0027 197709-0938-005
Historical Inactive 197412-0938-005
HHS/CMS
PORTABLE X-RAY SURVEY REPORT FORM
Revision of a currently approved collection   No
Regular
Not subject to PRA and continue 09/30/1977
Retrieve Notice of Action (NOA) 09/13/1977
  Inventory as of this Action Requested Previously Approved
09/30/1979 09/30/1979 09/30/1979
120 0 120
600 0 600
0 0 0



None
None


No

1
IC Title Form No. Form Name
PORTABLE X-RAY SURVEY REPORT FORM SSA-1882

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.
09/13/1977


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