View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0041	ICR Reference No: 198704-0938-004
Status: Historical Active	Previous ICR Reference No: 198412-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: THIRD PARTY PREMIUM BILLING REQUEST
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/01/1987
	Date Received in OIRA: 04/29/1987
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/1990	06/30/1990	11/30/1987
Responses	10,000	0	10,000
Time Burden (Hours)	2,500	0	2,500
Cost Burden (Dollars)	0	0	0

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