CONTRACTOR FINANCIAL REPORTS -- HCFA-750A

ICR 199306-0938-013

OMB: 0938-0634

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
114098 Migrated
ICR Details
0938-0634 199306-0938-013
Historical Active
HHS/CMS
CONTRACTOR FINANCIAL REPORTS -- HCFA-750A
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/09/1993
Retrieve Notice of Action (NOA) 06/11/1993
  Inventory as of this Action Requested Previously Approved
09/30/1994 09/30/1994
188 0 0
1,128 0 0
0 0 0

THE HEALTH CARE FINANCING ADMINISTRATION NEEDS TO SECURE FINANCIAL INFORMATION REGARDING MEDICARE BENEFITS FROM ITS 84 CONTRACTORS FOR INCLUSION IN ITS ANNUAL FINANCIAL STATEMENT IN ACCORDANCE WITH THE REQUIREMENTS OF THE CHIEF FINANCIAL OFFICERS ACT AND FOR QUARTERLY REPORTING TO THE U.S. TREASURY ON THE SF-220 SERIES OF FINANCIAL REPORTS.

None
None


No

1
IC Title Form No. Form Name
CONTRACTOR FINANCIAL REPORTS -- HCFA-750A HCFA-750A

  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 188 0 0 188 0 0
Annual Time Burden (Hours) 1,128 0 0 1,128 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.
06/11/1993


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