Bounceback Forms for www.Medicare.gov, www.4woman.gov, and www.healthfinder.gov

ICR 199904-0938-003

OMB: 0938-0756

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0756 199904-0938-003
Historical Active 199812-0938-012
HHS/CMS
Bounceback Forms for www.Medicare.gov, www.4woman.gov, and www.healthfinder.gov
Extension without change of a currently approved collection   No
Regular
Approved without change 06/22/1999
Retrieve Notice of Action (NOA) 04/15/1999
  Inventory as of this Action Requested Previously Approved
06/30/2002 06/30/2002 07/31/1999
212,185 0 212,185
21,221 0 21,221
0 0 0

DHHS has developed bounceback forms to obtain feedback from users accessing www.Medicare.gov, www.4woman.gov, and www.healthfinder.gov to obtain feedback from users of these sites to feed into future changes in the sites.

None
None


No

1
IC Title Form No. Form Name
Bounceback Forms for www.Medicare.gov, www.4woman.gov, and www.healthfinder.gov HCFA-R-268

  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 212,185 212,185 0 0 0 0
Annual Time Burden (Hours) 21,221 21,221 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
04/15/1999


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