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: 0938-0202	ICR Reference No: 199605-0938-004
Status: Historical Active	Previous ICR Reference No: 199304-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Home Office Cost Statement
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: 07/15/1996
	Date Received in OIRA: 05/08/1996
Terms of Clearance: Approved for use through 7/99 under the condition that HCFA immediately incorporates into the HCFA-287/instructions the disclosure statements required pursuant to the Paperwork Reduction Act of 1995 and its implementing regulations. HCFA must provide to OMB the revised form/instructions for the public record.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/1999	07/31/1999	07/31/1996
Responses	1,231	0	1,231
Time Burden (Hours)	573,646	0	573,646
Cost Burden (Dollars)	0	0	0

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