MEDICARE BENEFICIARY SURVEY

ICR 198905-0990-001

OMB: 0990-0181

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
167066
Migrated
ICR Details
0990-0181 198905-0990-001
Historical Active 198901-0990-001
HHS/HHSDM
MEDICARE BENEFICIARY SURVEY
No material or nonsubstantive change to a currently approved collection   No
Emergency 05/04/1989
Approved with change 05/04/1989
Retrieve Notice of Action (NOA) 05/04/1989
  Inventory as of this Action Requested Previously Approved
03/31/1990 03/31/1990 03/31/1990
640 0 640
214 0 214
0 0 0

THIS REQUEST FOR INFORMATION ON BENEFICIARY EXPERIENCE WITH THE MEDICA PROGRAM IS NEEDED TO DETERMINE BENEFICIARIES' AWARENESS OF, USE OF, AN CONCERNS WITH VARIOUS ASPECTS OF THE MEDICARE PROGRAM. THE INFORMATIO WILL BE USED TO IDENTIFY POTENTIAL INEFFICIENCY WHICH NEEDS MORE DETAILED REVIEW AND CORRECTIVE ACTION.

None
None


No

1
IC Title Form No. Form Name
MEDICARE BENEFICIARY SURVEY

  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 640 640 0 0 0 0
Annual Time Burden (Hours) 214 214 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
05/04/1989


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