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: 0938-0245	ICR Reference No: 199004-0938-004
Status: Historical Active	Previous ICR Reference No: 198703-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: REQUEST FOR ENROLLMENT IN SUPPLEMENTARY MEDICAL INSURANCE (SMI)
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: 06/18/1990
	Date Received in OIRA: 04/11/1990
Terms of Clearance: Approved for use through 12/91 under the condition that the next form submitted for OMB approval incorporates the burden disclosure statement pursuant to 5 CFR 1320.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/1991	12/31/1991	05/31/1990
Responses	40,000	0	40,000
Time Burden (Hours)	3,333	0	3,333
Cost Burden (Dollars)	0	0	0

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