View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0266	ICR Reference No: 199610-0938-005
Status: Historical Active	Previous ICR Reference No: 199310-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Ambulatory Surgical Center Request for Certification and Survey Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/06/1997
	Date Received in OIRA: 10/25/1996
Terms of Clearance: Approved for use through 1/2000 under the condition that the forms/instructions include the new disclosure statements mandated pursuant to the Paperwork Reduction Act of 1995. For the public record, HCFA must submit to OMB the revised forms/instructions.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2000	01/31/2000	12/31/1996
Responses	3,800	0	2,400
Time Burden (Hours)	1,425	0	900
Cost Burden (Dollars)	0	0	0

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