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Health Maintenance Organization Qualification Application, Health Maintenance Organization Expansion Application, Competitive Medical Plan Application

IC 110219 under ICR 198510-0915-003 · OMB 0915-0065.

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Information Collection (IC) Details

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HEALTH MAINTENANCE ORGANIZATION QUALIFICATION APPLICATION, HEALTH MAINTENANCE ORGANIZATION EXPANSION APPLICATION, COMPETITIVE MEDICAL PLAN APPLICATION
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HRSA-901-1 No No
Form 2, & 3 No No


    

195 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 195 0 0 135 0 60
Annual IC Time Burden (Hours) 19,500 0 0 13,500 0 6,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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