View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0960-0092	ICR Reference No: 197511-0960-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: APPLICATION FOR MEDICAL INSURANCE
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/25/1975
	Date Received in OIRA: 11/11/1975
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/1980	11/30/1980
Responses	90,000	0	0
Time Burden (Hours)	9,000	0	0
Cost Burden (Dollars)	0	0	0

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