View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0251	ICR Reference No: 198908-0938-007
Status: Historical Active	Previous ICR Reference No: 198607-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: APPLICATION FOR HOSPITAL INSURANCE
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: 11/21/1989
	Date Received in OIRA: 08/31/1989
Terms of Clearance: Approved for use through 5/91 under the condition that the next form submitted for OMB review incorporates the burden disclosure statement pursuant to 5 CFR 1320.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/1991	05/31/1991	08/31/1989
Responses	50,000	0	50,000
Time Burden (Hours)	12,500	0	12,500
Cost Burden (Dollars)	0	0	0

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