View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0041	ICR Reference No: 198412-0938-001
Status: Historical Active	Previous ICR Reference No: 198110-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: THIRD PARTY PREMIUM BILLING REQUEST
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/11/1985
	Date Received in OIRA: 12/03/1984
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/1987	11/30/1987
Responses	10,000	0	0
Time Burden (Hours)	2,500	0	0
Cost Burden (Dollars)	0	0	0

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