OMB
.report
Search
Health Maintenance Organizations/competitive Medical Plan National Data Reporting Requirements
HEALTH MAINTENANCE ORGANIZATIONS/COMPETITIVE MEDICAL PLAN NATIONAL DATA REPORTING REQUIREMENTS
OMB: 0915-0063
IC ID: 110213
OMB.report
HHS/HSA
OMB 0915-0063
ICR 198506-0915-004
IC 110213
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HEALTH MAINTENANCE ORGANIZATIONS/COMPETITIVE MEDICAL PLAN NATIONAL DATA REPORTING REQUIREMENTS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HRSA-905
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
269
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
985
0
263
-2
0
724
Annual IC Time Burden (Hours)
546
0
-12,857
118
0
13,285
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.