EVALUATION STUDY OF THE HMO CAPITATION DEMDEMONSTRATION

ICR 198205-0938-002

OMB: 0938-0256

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
113274 Migrated
ICR Details
0938-0256 198205-0938-002
Historical Active
HHS/CMS
EVALUATION STUDY OF THE HMO CAPITATION DEMDEMONSTRATION
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/16/1982
Retrieve Notice of Action (NOA) 05/21/1982
  Inventory as of this Action Requested Previously Approved
01/31/1983 01/31/1983
3,000 0 0
2,000 0 0
0 0 0

THE SURVEY WILL STUDY THE MARKETING EFFECTIVENESS OF HCFA'S HMO DEMONSTRATION PROJECTS ENROLLING MEDICARE BENEFICIARIES, THE POTENTIAL ENROLLMENT BIAS THAT MAY BE ASSOCIATED WITH AN ENROLLED HEALTH STATUS, AND THE EXTENT OF OUT-OF-PLAN USE AND OUT-OF-POCKET EXPENSES INCURRED HMO MEDICARE ENROLLEES AND NON-ENROLLED BENEFICIARIES.

None
None


No

1
IC Title Form No. Form Name
EVALUATION STUDY OF THE HMO CAPITATION DEMDEMONSTRATION HCFA-346, HCFA-346A

  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 3,000 0 0 3,000 0 0
Annual Time Burden (Hours) 2,000 0 0 2,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
05/21/1982


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