This collection
is approved for 3 years. Supporting Statement revised to include
Federal Cost estimate. Forms and Instructions packet revised
according to correspondence 4/29 and 5/5.
Inventory as of this Action
Requested
Previously Approved
07/31/2006
07/31/2006
05/31/2003
20
0
20
455
0
535
0
0
0
The submission of proposal information
by current QIOs and other bidders, on the appropriate forms, will
satisfy CMS's need for meaningful, consistent, and verifiable data
with which to evaluate contract proposals.
STAFFING, SC1, SC2, CMS-FORM-718BP, 719BP, 720BP, 721BP,
SUM
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
20
20
0
0
0
0
Annual Time Burden (Hours)
455
535
0
0
-80
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.