PROFESSIONAL STANDARDS REVIEW ORGANIZATION ROUTINE FEDERAL REPORTING REQUIREMENTS

ICR 197902-0938-003

OMB: 0938-0063

Federal Form Document

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Document
Name
Status
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IC Document Collections
ICR Details
0938-0063 197902-0938-003
Historical Active 197808-0938-003
HHS/CMS
PROFESSIONAL STANDARDS REVIEW ORGANIZATION ROUTINE FEDERAL REPORTING REQUIREMENTS
No material or nonsubstantive change to a currently approved collection   No
Emergency 02/12/1979
Approved with change 02/12/1979
Retrieve Notice of Action (NOA) 02/12/1979
  Inventory as of this Action Requested Previously Approved
03/31/1982 03/31/1982 12/31/1981
22,680 0 22,680
136,788 0 136,788
0 0 0

COLLECTION OF DATA IS AUTHORIZED BY SECTION 1155(F)(1)(B) OF THE CIAL SECURITY ACT. THE DATA COLLECTED THROUGH THIS SYSTEM IS USED TO MANAGE, MONITOR AND EVALUATE THE ACTIVITIES OF THE PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS.

None
None


No

1
IC Title Form No. Form Name
PROFESSIONAL STANDARDS REVIEW ORGANIZATION ROUTINE FEDERAL REPORTING REQUIREMENTS HCFA-111,, 112,121,, 122,131,, 135,141,, & 142J

  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 22,680 22,680 0 0 0 0
Annual Time Burden (Hours) 136,788 136,788 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.
02/12/1979


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