View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0080	ICR Reference No: 199609-0938-003
Status: Historical Active	Previous ICR Reference No: 199404-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Application for Health Insurance under Medicare for Individuals with Chronic Renal Disease
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/04/1996
	Date Received in OIRA: 09/04/1996
Terms of Clearance: Approved for use through 11/99 under the condition that HCFA immediately incorporates the disclosure statements mandated by the Paperwork Reduction Act of 1995. HCFA must submit the revised forms/instructions to OMB for the public record.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/1999	11/30/1999
Responses	80,000	0	0
Time Burden (Hours)	34,400	0	0
Cost Burden (Dollars)	0	0	0

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