Evaluation of the Demonstration of Coverage of Chiropractic Services Under Medicare

ICR 200606-0938-009

OMB: 0938-0998

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
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ICR Details
0938-0998 200606-0938-009
Historical Active
HHS/CMS
Evaluation of the Demonstration of Coverage of Chiropractic Services Under Medicare
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 10/16/2006
Retrieve Notice of Action (NOA) 06/21/2006
Approved contingent upon memo dated 10/4/2006.
  Inventory as of this Action Requested Previously Approved
10/31/2009 36 Months From Approved
2,000 0 0
667 0 0
0 0 0

RTOP No. CMS-05-030/CN requires this new collection which consists of a survey of Medicare beneficiaries using expanded chiropractic services in the states covered by the Demonstration of Coverage of Chiropractic Services Under Medicare.

None
None


No

1
IC Title Form No. Form Name
Evaluation of the Demonstration of Coverage of Chiropractic Services Under Medicare CMS-10187, CMS-10187-SP

  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 2,000 0 0 2,000 0 0
Annual Time Burden (Hours) 667 0 0 667 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.
06/21/2006


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