MONTHLY CONTRACTOR FINANCIAL REPORT (HCFA 1522)/CONTRACTOR DRAWS ON LETTER OF CREDIT (HCFA 1521)

ICR 198906-0938-015

OMB: 0938-0361

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0361 198906-0938-015
Historical Active 198904-0938-022
HHS/CMS
MONTHLY CONTRACTOR FINANCIAL REPORT (HCFA 1522)/CONTRACTOR DRAWS ON LETTER OF CREDIT (HCFA 1521)
No material or nonsubstantive change to a currently approved collection   No
Emergency 06/16/1989
Approved with change 06/16/1989
Retrieve Notice of Action (NOA) 06/16/1989
  Inventory as of this Action Requested Previously Approved
08/31/1990 08/31/1990 08/31/1990
110 0 110
29,040 0 29,040
0 0 0

THESE REPORTS ARE COMPLETED ON A MONTHLY BASIS BY MEDICARE CONTRACTORS ACCOUNT FOR FOR THE EXPENDITURE OF FEDERAL FUNDS FOR MEDICARE PROGRAM AND RELATED ADMINISTRATIVE COSTS. HCFA REVIEWS THE REPORTS TO ENSURE THAT CONTRACTORS DO NOT OVERDRAW THEIR U.S. TREASURY ACCOUNTS AND ACCOUNT F ALLOTED ADMINISTRATIVE COSTS. ALSO, DATA IS USED BY HCFA ACTUARY TO MONITOR MEDICARE TRUST FUND PROJECTIONS.

None
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No

1
IC Title Form No. Form Name
MONTHLY CONTRACTOR FINANCIAL REPORT (HCFA 1522)/CONTRACTOR DRAWS ON LETTER OF CREDIT (HCFA 1521) HCFA-1522, HCFA-1521

  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 110 110 0 0 0 0
Annual Time Burden (Hours) 29,040 29,040 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.
06/16/1989


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