MEDICAL COST DATA

ICR 199111-0960-008

OMB: 0960-0469

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
115618 Migrated
ICR Details
0960-0469 199111-0960-008
Historical Active 198904-0960-023
SSA
MEDICAL COST DATA
Extension without change of a currently approved collection   No
Regular
Approved without change 01/29/1992
Retrieve Notice of Action (NOA) 11/21/1991
  Inventory as of this Action Requested Previously Approved
01/31/1995 01/31/1995 03/31/1992
54 0 54
54 0 54
0 0 0

THE INFORMATION IS USED TO MAKE PROJECTIONS OF MEDICAL COSTS TO BE INCURRED BY THE STATE AGENCIES. THE RESPONDENTS ARE STATE DISABILITY DETERMINATION SERVICES.

None
None


No

1
IC Title Form No. Form Name
MEDICAL COST DATA SSA-2722

  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 54 54 0 0 0 0
Annual Time Burden (Hours) 54 54 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.
11/21/1991


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