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According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it

ICR 201110-0938-008 · OMB 0938-0269 · Object 28166101.

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File Type	application/msword
File Title	According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
Author	HCFA Software Control
Last Modified By	Writer
File Modified	2011-10-12
File Created	2026-11-15
Conversion State	complete

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PRA Disclosure Statement




According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0938-0269.  The time required to complete this information collection is estimated to average 
(0.50 hour) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.