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: 0938-0850	ICR Reference No: 200704-0938-003
Status: Historical Active	Previous ICR Reference No: 200312-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: State Health Insurance Assistance Program (SHIP) Client Contact Form, Pubic and Media Activity Form, and Resource Report Form.
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 without change	Conclusion Date: 06/19/2007
	Date Received in OIRA: 04/15/2007
Terms of Clearance: CMS will continue to update OMB on progress toward coordination with AoA's NAPIS system.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2010	36 Months From Approved	06/30/2007
Responses	1,056,000	0	1,000,000
Time Burden (Hours)	87,965	0	116,747
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,056,000	1,000,000	56,000
Annual Time Burden (Hours)	87,965	116,747	-28,782
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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