Information Collection Request

Certificate of Coverage Request

ICR 201401-0960-006 · OMB 0960-0554 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Justification for the Non-Substantive Changes - 0554.doc Justification for No Material/Nonsubstantive Change Uploaded 2014-02-04 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2016 10/31/2016 10/31/2016
81,000 0 70,000
54,233 0 46,900
0 0 0





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 81,000 70,000 0 11,000 0 0
Annual Time Burden (Hours) 54,233 46,900 0 7,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No