CONTRACTORS INFORMATION COLLECTIONS - SOLE COMMUNITY PROVIDER EXEMPTION REQUESTS

ICR 198112-0938-010

OMB: 0938-0229

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
0938-0229 198112-0938-010
Historical Active
HHS/CMS
CONTRACTORS INFORMATION COLLECTIONS - SOLE COMMUNITY PROVIDER EXEMPTION REQUESTS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/18/1981
Retrieve Notice of Action (NOA) 12/04/1981
  Inventory as of this Action Requested Previously Approved
03/31/1982 03/31/1982
80 0 0
80 0 0
0 0 0

HCFA'S DENVER REGIONAL OFFICE ALLOWED HOSPITALS TO REQUEST EXEMPTION TO COST CONTAINMENT LIMITS ON THE BASIS THAT THEY WERE THE SOLE PROVID IN THE COMMUNITY. THESE FORMS DOCUMENTED THIS SITUATION. THE USE OF THESE FORMS WILL BE DISCONTINUED.

None
None


No

1
IC Title Form No. Form Name
CONTRACTORS INFORMATION COLLECTIONS - SOLE COMMUNITY PROVIDER EXEMPTION REQUESTS HCFA-9041

  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 80 0 0 0 80 0
Annual Time Burden (Hours) 80 0 0 0 80 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.
12/04/1981


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