PACEMAKER RELATED DATA

ICR 199106-0938-005

OMB: 0938-0436

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
113718 Migrated
ICR Details
0938-0436 199106-0938-005
Historical Active 198904-0938-005
HHS/CMS
PACEMAKER RELATED DATA
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 08/21/1991
Retrieve Notice of Action (NOA) 06/17/1991
  Inventory as of this Action Requested Previously Approved
08/31/1994 08/31/1994
165,000 0 0
22,000 0 0
0 0 0

THIS DATA COLLECTION WILL COLLECT INFORMATION FROM PROVIDERS AND MANUFACTURERS. THE INFORMATION IS NEEDED TO ASSIST IN THE DEVELOPMENT OF FDA'S REGISTRY FILE AS WELL AS TO IDENTIFY WHEN MANUFACTURER WARRANTY SUPERCEEDS MEDICARE REIMBURSEMENT.

None
None


No

1
IC Title Form No. Form Name
PACEMAKER RELATED DATA HCFA-497

  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 165,000 0 0 165,000 0 0
Annual Time Burden (Hours) 22,000 0 0 22,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
06/17/1991


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