Information Collection

Health Maintenance Organization National Data Reporting Requirements

IC 110211 under ICR 198308-0915-010 · OMB 0915-0063.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0063 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	HEALTH MAINTENANCE ORGANIZATION NATIONAL DATA REPORTING REQUIREMENTS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PHS-6080				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 172	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	724	188	536
Annual IC Time Burden (Hours)	13,285	2,565	10,720
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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