Information Collection

Annual Survey Of Independent Prepaid And Self-insured Health Plans

IC 113257 under ICR 198509-0938-002 · OMB 0938-0249.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0249 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	ANNUAL SURVEY OF INDEPENDENT PREPAID AND SELF-INSURED HEALTH PLANS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-1807				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 725	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	725	525	200
Annual IC Time Burden (Hours)	344	144	200
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.