PROFESSIONAL STANDARDS REVIEW ORGANIZATION ROUTINE FEDERAL REPORTING REQUIREMENTS

ICR 197712-0938-003

OMB: 0938-0063

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0063 197712-0938-003
Historical Active 197611-0938-001
HHS/CMS
PROFESSIONAL STANDARDS REVIEW ORGANIZATION ROUTINE FEDERAL REPORTING REQUIREMENTS
Extension without change of a currently approved collection   No
Regular
Approved without change 12/01/1977
Retrieve Notice of Action (NOA) 12/01/1977
  Inventory as of this Action Requested Previously Approved
06/30/1978 06/30/1978 12/31/1977
13,200 0 13,200
68,000 0 68,000
0 0 0



None
None


No

1
IC Title Form No. Form Name
PROFESSIONAL STANDARDS REVIEW ORGANIZATION ROUTINE FEDERAL REPORTING REQUIREMENTS HSABQA 0606

  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 13,200 13,200 0 0 0 0
Annual Time Burden (Hours) 68,000 68,000 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.
12/01/1977


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