PREFERRED PROVIDER ORGANIZATION STUDY

ICR 198712-0990-001

OMB: 0990-0175

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
116741
Migrated
ICR Details
0990-0175 198712-0990-001
Historical Active
HHS/HHSDM
PREFERRED PROVIDER ORGANIZATION STUDY
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 02/24/1988
Retrieve Notice of Action (NOA) 12/28/1987
  Inventory as of this Action Requested Previously Approved
10/31/1988 10/31/1988
1,575 0 0
210 0 0
0 0 0

THE PHSICIAN SURVEY WILL GATHER INFORMATION TO DESCRIBE WHY THE PHYSICIAN JOINED THE PPO, WHETHER HE/SHE BELONGS TO OTHER PPOS, AND WHAT HIS/HER EXPERIENCES HAVE BEEN WITH THE PPOS.

None
None


No

1
IC Title Form No. Form Name
PREFERRED PROVIDER ORGANIZATION STUDY

  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 1,575 0 0 1,575 0 0
Annual Time Burden (Hours) 210 0 0 210 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
12/28/1987


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