Information Collection

Health Maintenance Organizations/competitive Medical Plan National Data Reporting Requirements

IC 110213 under ICR 198506-0915-004 · OMB 0915-0063.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

HEALTH MAINTENANCE ORGANIZATIONS/COMPETITIVE MEDICAL PLAN 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HRSA-905				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 269

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	985	263	-2	724
Annual IC Time Burden (Hours)	546	-12,857	118	13,285
Annual IC Cost Burden (Dollars)	0	0	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.

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