View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0041	ICR Reference No: 200310-0938-001
Status: Historical Active	Previous ICR Reference No: 200008-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Third Party Premium Billing Request and Supporting Regulations in 42 CFR 408.6 and 408.202
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/14/2003
	Date Received in OIRA: 10/01/2003
Terms of Clearance: Approved on the condition that the form is immediately revised to reflect the change listed in CMS memo dated 11/14/2003. CMS will rephrase the sentence for requesting bills be sent to another person.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2006	11/30/2006	11/30/2003
Responses	17,350	0	15,000
Time Burden (Hours)	6,446	0	6,250
Cost Burden (Dollars)	0	0	0

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