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: 0938-0086	ICR Reference No: 199108-0938-010
Status: Historical Active	Previous ICR Reference No: 198903-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: MEDICARE/MEDICAID - DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
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: 11/27/1991
	Date Received in OIRA: 08/29/1991
Terms of Clearance: Approved for use through 11/93 under the condition that the next submission for OMB review contains an analysis of potential redundancy of this effort with separate provider-specific collections implementin statutory provisions in the last five years. In particular, this analysis should include recommendations for reducing such redundancy and unnecessary burden, while ensuring that basic statutory objectives related to health care entity financial interest are achieved. If appropriate, recommendations may include legislative amendments.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/1993	11/30/1993
Responses	40,000	0	0
Time Burden (Hours)	20,000	0	0
Cost Burden (Dollars)	0	0	0

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