Information Collection

Evaluation Of Social/health Maintenance Organization (s/hmo) Demonstration

IC 113762 under ICR 198811-0938-004 · OMB 0938-0450.

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Information Collection (IC) Details

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IC Title:	EVALUATION OF SOCIAL/HEALTH MAINTENANCE ORGANIZATION (S/HMO) DEMONSTRATION	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-506				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,991	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,991	-9	3,000
Annual IC Time Burden (Hours)	2,991	0	2,991
Annual IC Cost Burden (Dollars)	0	0	0

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