View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0270	ICR Reference No: 200407-0938-002
Status: Historical Active	Previous ICR Reference No: 200107-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: The Financial Statement of Debtor and Supporting Regulations in 42 CFR, Section 405.376
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 with change	Conclusion Date: 09/16/2004
	Date Received in OIRA: 07/14/2004
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2007	09/30/2007	09/30/2004
Responses	500	0	500
Time Burden (Hours)	1,000	0	1,000
Cost Burden (Dollars)	0	0	0

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