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Medicare+Choice Provider Sponsored Organization Waiver Request Form and Supporting Regulations at 42 CFR 422.370 through 422.378
Medicare+Choice Provider Sponsored Organization Waiver Request Form and Supporting Regulations at 42 CFR 422.370 through 422.378
OMB: 0938-0722
IC ID: 8382
OMB.report
HHS/CMS
OMB 0938-0722
ICR 200107-0938-008
IC 8382
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medicare+Choice Provider Sponsored Organization Waiver Request Form and Supporting Regulations at 42 CFR 422.370 through 422.378
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HCFA-R-231
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10
0
0
-20
0
30
Annual IC Time Burden (Hours)
100
0
0
-200
0
300
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.