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: 0938-0953	ICR Reference No: 201409-0938-007
Status: Historical Active	Previous ICR Reference No: 201112-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Notice of Provider Non-Coverage (CMS-10123) and Detailed Explanation of Non-Coverage (CMS-10124)
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: 11/24/2014
	Date Received in OIRA: 09/16/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved	12/31/2014
Responses	5,339,849	0	5,339,849
Time Burden (Hours)	927,931	0	927,931
Cost Burden (Dollars)	0	0	0

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