Data Collection for the Second Generation Social Health Maintenance Organization Demonstration

ICR 199709-0938-007

OMB: 0938-0709

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0709 199709-0938-007
Historical Active
HHS/CMS
Data Collection for the Second Generation Social Health Maintenance Organization Demonstration
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/26/1997
Retrieve Notice of Action (NOA) 09/16/1997
  Inventory as of this Action Requested Previously Approved
09/30/2000 09/30/2000
137,271 0 0
133,652 0 0
0 0 0

The data collected under this effort will be used to support the operational and evaluation needs of the congressionally mandated second generation of the Social Health Maintenance Organization Demonstration.

None
None


No

1
IC Title Form No. Form Name
Data Collection for the Second Generation Social Health Maintenance Organization Demonstration HCFA-R-204

  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 137,271 0 0 137,271 0 0
Annual Time Burden (Hours) 133,652 0 0 133,652 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
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.
09/16/1997


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