View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-0065	ICR Reference No: 198907-0938-005
Status: Historical Active	Previous ICR Reference No: 198904-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: MEDICARE - REQUEST TO ESTABLISH ELIGIBILITY IN THE MEDICARE AND/OR MEDICAID PROGRAM TO PROVIDE OUTPATIENT PHYSICAL THERAPY AND/OR SPEECH PATHOLOGY SERVICES - OUTPATIENT ....
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: 09/14/1989
	Date Received in OIRA: 07/13/1989
Terms of Clearance: Approved for use through 9/92 under the condition that the next submission contains all surveyor guidance related to the survey forms.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1992	09/30/1992
Responses	313	0	0
Time Burden (Hours)	548	0	0
Cost Burden (Dollars)	0	0	0

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