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.

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Information Collection (IC) Details

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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:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	111	No	No
Form	121	No	No
Form	121-B	No	No
Form	135	No	No
Form	153	No	No
Form	SF 269	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 %

	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

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