Information Collection

Information Collection Requirements Concerning Claims Processing Assessment System (cpas), Hcfa R-91, Hcfa-331, Hcfa-503, & Currently Approved Hcfa-r-93 To Be Consolidated

IC 113723 under ICR 198911-0938-006 · OMB 0938-0438.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0438 can be found here:

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENTS CONCERNING CLAIMS PROCESSING ASSESSMENT SYSTEM (CPAS), HCFA R-91, HCFA-331, HCFA-503, & CURRENTLY APPROVED HCFA-R-93 TO BE CONSOLIDATED	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.	Available Electronically?	Can Be Submitted Electronically?
Form	331, 503	No	No
Form	HCFA-R-91	No	No
Form	R-83	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	66,185	66,185
Annual IC Cost Burden (Dollars)	0	0

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Title	Document	Date Uploaded

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