EVALUATION OF SECOND SURGICAL OPINION PROGRAMS FOR ELECTIVE SURGERY

ICR 198012-0938-002

OMB: 0938-0131

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0131 198012-0938-002
Historical Active 197908-0938-003
HHS/CMS
EVALUATION OF SECOND SURGICAL OPINION PROGRAMS FOR ELECTIVE SURGERY
Revision of a currently approved collection   No
Regular
Approved without change 01/26/1981
Retrieve Notice of Action (NOA) 12/30/1980
  Inventory as of this Action Requested Previously Approved
02/28/1982 02/28/1982 02/28/1981
1,366 0 1,366
1,275 0 1,275
0 0 0

NEED: TO ENCOURAGE PATIENTS CONSIDERING SURVERY TO OBTAIN ADVICE ON WHICH TO BASE THEIR DECISION ABOUT WHETHER TO HAVE SURGERY. USE: TO DETERMINE WHAT HAPPENS AFTER PATIENTS CONTACT THE NSSOP AND HO PATIENTS FEEL ABOUT THE SSO PROCESS IN WHICH THEY HAVE BEEN ENGAGED.

None
None


No

1
IC Title Form No. Form Name
EVALUATION OF SECOND SURGICAL OPINION PROGRAMS FOR ELECTIVE SURGERY HCFA-6, HCFA-6A, HCFA-L-6

  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 1,366 1,366 0 0 0 0
Annual Time Burden (Hours) 1,275 1,275 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.
12/30/1980


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