Information Collection Request

Centenarian Project and Medicare Non-Utilzation Project Development Worksheets: Face-to-Face Interview; Telephone Interview

ICR 201512-0960-005 · OMB 0960-0780 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Supporting Statement - 0780.docx Supporting Statement A Uploaded 2016-03-18 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
208156 Medicare Non-utilization Project (MNUP) Other-Interview Worksheet Modified
191770 Centenarian Project Title XVI Only Other-Interview Worksheet Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2019 36 Months From Approved 06/30/2016
4,640 0 16,000
1,160 0 4,000
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Centenarian Project Title XVI Only
Medicare Non-utilization Project (MNUP)

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 4,640 16,000 0 0 -11,360 0
Annual Time Burden (Hours) 1,160 4,000 0 0 -2,840 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No