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: 0938-0935	ICR Reference No: 200501-0938-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Qualification-Medicare Advantage Application for Coordinated Care Private Fee-For-Service, Regional Preferred Preferred Provider Organization, Service Area Expansion for Coordinated Care.......
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 01/21/2005
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/21/2005
	Date Received in OIRA: 01/19/2005
Terms of Clearance: This information collection is approved with the following condition of clearance. HHS/CMS will solicit comments on the application during the scheduled training sessions and will report back to OMB within one week of the conclusion of these sessions with a plan to address these comments through modifying the application, issuing clarifying instructions, or other means.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2005	06/30/2005
Responses	350	0	0
Time Burden (Hours)	20,100	0	0
Cost Burden (Dollars)	0	0	0

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