Information Collection

Psro Routine Federal Reporting Requirements, Hcfa 111, 121-b 135, 153, Sf 269

IC 113324 under ICR 198212-0938-012 · OMB 0938-0275.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

IC Title:

PSRO ROUTINE FEDERAL REPORTING REQUIREMENTS, HCFA 111, 121-B 135, 153, SF 269

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	111	No	No
Form	153	No	No
Form	121	No	No
Form	121-B	No	No
Form	SF 269	No	No
Form	135	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,684

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	7,684	7,684
Annual IC Time Burden (Hours)	33,320	33,320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].