REQUIREMENT TO DISCLOSE HMO FINANCIAL INFORMATION TO MEMBERS

ICR 199405-0938-002

OMB: 0938-0472

Federal Form Document

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Name
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ICR Details
0938-0472 199405-0938-002
Historical Active 199104-0938-002
HHS/CMS
REQUIREMENT TO DISCLOSE HMO FINANCIAL INFORMATION TO MEMBERS
Revision of a currently approved collection   No
Regular
Approved without change 08/10/1994
Retrieve Notice of Action (NOA) 05/25/1994
  Inventory as of this Action Requested Previously Approved
05/31/1997 05/31/1997 05/31/1994
413 0 413
206 0 206
0 0 0

S' 47 CFR 417.107(C)(1) REQUIRES HMO'S TO DISCLOSE SPECIFIC INFORMATION T MEMBERS, POTENTIAL MEMBERS, EMPLOYEES, AND CONTRACTORS. THIS RULE LIS THE INFORMATION WHICH CAN BE DISCLOSED.

None
None


No

1
IC Title Form No. Form Name
REQUIREMENT TO DISCLOSE HMO FINANCIAL INFORMATION TO MEMBERS HCFA R-97

  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 413 413 0 0 0 0
Annual Time Burden (Hours) 206 206 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.
05/25/1994


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