Information Collection

HDCI 2 Survey of Group Health Plans

IC 178579 under ICR 200702-1210-001 · OMB 1210-0129.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HDCI Telephone Questionnaire 11 1 06.doc	Other-HDCI Telephone Questionnaire
telephone script revised OMB 4-26 clean.doc	Other-HDCI 2 Telephone Script

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HDCI 2 Telephone Script			telephone script revised OMB 4-26 clean.doc		Yes	Yes	Fillable Fileable
Other-HDCI Telephone Questionnaire			HDCI Telephone Questionnaire 11 1 06.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.