PROVIDER DATA COLLECTION

ICR 198310-0990-003

OMB: 0990-0119

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
116627
Migrated
ICR Details
0990-0119 198310-0990-003
Historical Active
HHS/HHSDM
PROVIDER DATA COLLECTION
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/15/1983
Retrieve Notice of Action (NOA) 10/06/1983
  Inventory as of this Action Requested Previously Approved
09/30/1984 09/30/1984
1,696 0 0
1,611 0 0
0 0 0

THE PRINCIPAL NEED AND USE IS TO COLLECT RESEARCH DATA FROM SERVICE PROVIDERS TO TEST THE HYPOTHESES OUTLINED IN THE SUPPORTING STATEMENT FOR THE EVALUATION OF THE LONG TERM CARE CHANNELING DEMONSTRATION. THESE HYPOTHESES FOCUS ON THE COSTS OF LONG TERM CARE SERVICES.

None
None


No

1
IC Title Form No. Form Name
PROVIDER DATA COLLECTION

  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 1,696 0 0 1,696 0 0
Annual Time Burden (Hours) 1,611 0 0 1,611 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.
10/06/1983


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