Information Collection Request

Model Employer CHIP Notice

ICR 201001-1210-001 · OMB 1210-0137 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
1210-0NEW- SS_CHIPRAERNotice.doc Supporting Statement A Uploaded 2010-01-05 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
191695 Model Employer CHIP Notice Other-Model Employer CHIP Notice New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2010 6 Months From Approved
203,795,000 0 0
1,053,000 0 0
25,271,000 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Model Employer CHIP Notice

table that charts list of burden
  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 203,795,000 0 203,795,000 0 0 0
Annual Time Burden (Hours) 1,053,000 0 1,053,000 0 0 0
Annual Cost Burden (Dollars) 25,271,000 0 25,271,000 0 0 0


Reginfo record details
  No