View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0266	ICR Reference No: 200412-0938-001
Status: Historical Active	Previous ICR Reference No: 200301-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Ambulatory Surgical Center (ASC) Health Insurance Benefits Agreement Form, Request for Certification, Survey Report and Supporting Regulations in 42 CFR 416.41, 416.43, 416.47, and...
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: 02/05/2005
	Date Received in OIRA: 12/08/2004
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2008	02/29/2008	04/30/2006
Responses	4,312	0	3,675
Time Burden (Hours)	2,381	0	1,875
Cost Burden (Dollars)	0	0	0

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