View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0251	ICR Reference No: 198607-0938-003
Status: Historical Active	Previous ICR Reference No: 198408-0938-021
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: APPLICATION FOR HOSPITAL 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: 08/27/1986
	Date Received in OIRA: 07/29/1986
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/1989	08/31/1989	10/31/1986
Responses	50,000	0	25,000
Time Burden (Hours)	12,500	0	6,250
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	50,000	25,000	15,000	10,000
Annual Time Burden (Hours)	12,500	6,250	3,750	2,500
Annual Cost Burden (Dollars)	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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