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: 0938-0958	ICR Reference No: 201212-0938-002
Status: Historical Active	Previous ICR Reference No: 200807-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Monthly State File of Medicaid/Medicare Dual Eligible Enrollees (CMS-10143)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/08/2013
	Date Received in OIRA: 12/07/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2016	36 Months From Approved
Responses	612	0	0
Time Burden (Hours)	6,120	0	0
Cost Burden (Dollars)	0	0	0

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.