REQUIREMENT TO DISCLOSE HMO FINANCIAL INFORMATION TO MEMBERS

ICR 198103-0937-004

OMB: 0937-0093

Federal Form Document

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Document
Name
Status
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IC Document Collections
ICR Details
0937-0093 198103-0937-004
Historical Active
HHS/OASH
REQUIREMENT TO DISCLOSE HMO FINANCIAL INFORMATION TO MEMBERS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 03/27/1981
Retrieve Notice of Action (NOA) 03/23/1981
  Inventory as of this Action Requested Previously Approved
04/30/1982 04/30/1982
120 0 0
60 0 0
0 0 0

RECORDKEEPING REQUIREMENT - HMO'S GENERALLY PROVIDE TO MEMBERS AND POTENTIAL MEMBERS THE INFORMATION LISTED AT 42 CFR 110.108(C)(1) IN THEIR PROMOTION LITERATURE AS A NORMAL BUSINESS PRACTICE EXCEPT FOR THE DETAILED FINANCIAL INFORMATION ITEM WHICH IS PROVIDED TO EACH EMPLOYER MANDATED UNDER SECTION 1310 OF THE PHS ACT, AS AMENDED. IN ADDITION, ALL OF THIS INFORMATION MUST BE FURNISHED OHMO IN THE HMO'S APPLICATION FOR FEDERAL QUALIFICATION.

None
None


No

1
IC Title Form No. Form Name
REQUIREMENT TO DISCLOSE HMO FINANCIAL INFORMATION TO MEMBERS

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 120 0 0 120 0 0
Annual Time Burden (Hours) 60 0 0 60 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/23/1981


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