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: 0938-1264	ICR Reference No: 201412-0938-004
Status: Historical Active	Previous ICR Reference No: 201409-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Health Plan Monitoring System Level I and Level II Data Entry for the Program of all-Inclusive Care for the Elderly (CMS-10525)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/16/2014
	Date Received in OIRA: 12/16/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved
Responses	24,000	0	0
Time Burden (Hours)	6,000	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to New Statute	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	24,000	40,000	-40,000	24,000
Annual Time Burden (Hours)	6,000	40,000	-40,000	6,000
Annual Cost Burden (Dollars)	0	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:

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