View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0915-0293	ICR Reference No: 200507-0915-003
Status: Historical Active	Previous ICR Reference No: 200503-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Free Clinics FTCA Program Application
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: 08/31/2005
	Date Received in OIRA: 07/07/2005
Terms of Clearance: Approved consistent with the following terms of clearance: HRSA shall continue to require information regarding the medical malpractice history of all individuals added through the supplemental form as well as in the annual application submitted by each free clinic.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2008	08/31/2008	08/31/2005
Responses	150	0	600
Time Burden (Hours)	2,400	0	3,000
Cost Burden (Dollars)	0	0	0

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