HDCI 2 Survey of Group Health Plans

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HDCI 2 Survey of Group Health Plans	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.