Information Collection

Health Maintenance Organizations/competitive Medical Plans National Data Reporting Requirements

IC 113804 under ICR 198608-0938-007 · OMB 0938-0469.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0469 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	HEALTH MAINTENANCE ORGANIZATIONS/COMPETITIVE MEDICAL PLANS NATIONAL DATA REPORTING REQUIREMENTS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-906				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 420	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,538	553	985
Annual IC Time Burden (Hours)	852	238	614
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.