Information Collection Request

Pharmacy Billing Requirements

ICR 201209-1240-002 · OMB 1240-0050 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
DOL-ESA-49 (EEOICPA).pdf Supplementary Document Uploaded 2012-11-05 Available
1240-0050 Supporting Stmt Aug 2012.doc Supporting Statement A Uploaded 2012-12-14 Available
DOL-ESA-6 (BLBA).pdf Supplementary Document Uploaded 2012-11-05 Available
DOL-GOVT-1 (FECA).pdf Supplementary Document Uploaded 2012-11-05 Available
20 CFR 725.701 and 725.705 BLBA Supporting Reg.pdf Supplementary Document Uploaded 2012-11-05 Available
20 CFR 30.701 EEOICPA Supporting Reg.pdf Supplementary Document Uploaded 2012-11-05 Available
20 CFR 10.801 FECA Supporting Reg.pdf Supplementary Document Uploaded 2012-11-05 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
38474 Pharmacy Billing Requirements Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2016 36 Months From Approved 01/31/2013
1,489,532 0 1,463,800
26,917 0 121,494
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
Pharmacy Billing Requirements

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 1,489,532 1,463,800 0 0 25,732 0
Annual Time Burden (Hours) 26,917 121,494 0 0 -94,577 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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