REIMBURSEMENT INFORMATION - PSYCHIATRIC RESIDENTIAL TREATMENT CENTERS SERVING CHILDREN AND ADOLESCENTS

ICR 199012-0704-005

OMB: 0704-0295

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0704-0295 199012-0704-005
Historical Active 198903-0704-006
DOD/DODDEP
REIMBURSEMENT INFORMATION - PSYCHIATRIC RESIDENTIAL TREATMENT CENTERS SERVING CHILDREN AND ADOLESCENTS
Revision of a currently approved collection   No
Regular
Approved without change 02/01/1991
Retrieve Notice of Action (NOA) 12/24/1990
  Inventory as of this Action Requested Previously Approved
01/31/1994 01/31/1994 03/31/1992
20 0 85
240 0 1,020
0 0 0

THE DATA COLLECTED FROM THIS INSTRUMENT (FORM) WILL BE USED IN CALCULATING THE PROSPECTIVE PER DIEM RATES FOR NEW RESIDENTIAL TREATMENT CENTERS SEEKING CERTIFICATION UNDER THE CHAMPUS RESIDENTIAL TREATMENT CENTER PROGRAM.

None
None


No

1
IC Title Form No. Form Name
REIMBURSEMENT INFORMATION - PSYCHIATRIC RESIDENTIAL TREATMENT CENTERS SERVING CHILDREN AND ADOLESCENTS CHAMPUS, FORM 771

  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 20 85 0 -65 0 0
Annual Time Burden (Hours) 240 1,020 0 -780 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
12/24/1990


© 2024 OMB.report | Privacy Policy