PORTABLE X-RAY SURVEY REPORT FORM

ICR 197710-0938-008

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
112554 Migrated
ICR Details
0938-0027 197710-0938-008
Historical Active 197709-0938-005
HHS/CMS
PORTABLE X-RAY SURVEY REPORT FORM
Revision of a currently approved collection   No
Regular
Approved without change 10/03/1977
Retrieve Notice of Action (NOA) 10/03/1977
  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 HCFA-1882

  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 120 120 0 0 0 0
Annual Time Burden (Hours) 600 600 0 0 0 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.
10/03/1977


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