Information Collection

Nationwide Survey Of Independent Prepaid And Self-insured Health Plans

IC 112465 under ICR 198001-0938-001 · OMB 0938-0001.

Documents and Forms

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Information Collection (IC) Details

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IC Title:	NATIONWIDE SURVEY OF INDEPENDENT PREPAID AND SELF-INSURED HEALTH PLANS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-1807,	No	No
Form	HCFA-L-1807,	No	No
Form	HCFA-L-1807A	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	900	900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.