REQUIREMENT TO DISCLOSE HMO FINANCIAL INFORMATION TO MEMBERS

ICR 198506-0915-003

OMB: 0915-0064

Federal Form Document

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IC Document Collections
ICR Details
0915-0064 198506-0915-003
Historical Active 198408-0915-010
HHS/HSA
REQUIREMENT TO DISCLOSE HMO FINANCIAL INFORMATION TO MEMBERS
Revision of a currently approved collection   No
Regular
Approved without change 08/29/1985
Retrieve Notice of Action (NOA) 06/26/1985
  Inventory as of this Action Requested Previously Approved
08/31/1986 08/31/1986 06/30/1985
260 0 210
130 0 105
0 0 0

HEALTH MAINTENANCE ORGANIZATIONS GENERALLY MAKE AVAILABLE THE INFORMATION LISTED AT 42 CFR 110.108(C)(1) TO MEMBERS AND POTENTIAL MEMBERS IN THEIR PROMOTION LITERATURE AS A NORMAL BUSINESS PRACTICE, EXCEPT FOR THE DETAILED FINANCIAL INFORMATION REQUIRED BY 110.108(C0) (1)(VIII).

None
None


No

1
IC Title Form No. Form Name
REQUIREMENT TO DISCLOSE HMO FINANCIAL INFORMATION TO MEMBERS

  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 260 210 0 0 50 0
Annual Time Burden (Hours) 130 105 0 0 25 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
06/26/1985


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