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: 0938-0626	ICR Reference No: 201002-0938-002
Status: Historical Active	Previous ICR Reference No: 200607-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Electronic Funds Transfer Authorization Agreement
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/20/2010
	Date Received in OIRA: 02/04/2010
Terms of Clearance: OMB notes that CMS made changes to the instrument after submission to address public comments received during the 30-day comment period.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2013	36 Months From Approved
Responses	100,000	0	0
Time Burden (Hours)	100,000	0	0
Cost Burden (Dollars)	0	0	0

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