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Federal forms, ICRs, and supporting documents

Information Collection Request

APPLICATIONS TO PARTICIPATE IN THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM AND CONTRACTOR RECORDS RETENTION COMPREHENSIVE MEDICAL PLANS

ICR 199503-3206-004 · OMB 3206-0145 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
156964 APPLICATIONS TO PARTICIPATE IN THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM AND CONTRACTOR RECORDS RETENTION COMPREHENSIVE MEDICAL PLANS Migrated
ICR Details
3206-0145 199503-3206-004
Historical Active 199202-3206-002
OPM
APPLICATIONS TO PARTICIPATE IN THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM AND CONTRACTOR RECORDS RETENTION COMPREHENSIVE MEDICAL PLANS
Extension without change of a currently approved collection   No
Regular
Approved without change 06/01/1995
Retrieve Notice of Action (NOA) 03/23/1995
  Inventory as of this Action Requested Previously Approved
06/30/1998 06/30/1998 06/30/1995
49 0 0
13,530 0 7,050
0 0 0
THIS INFORMATION COLLECTION IS USED BY OPM TO DETERMINE IF COMPREHENSIVE MEDICAL PLANS APPLYING FOR PARTICIPATION IN THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM MEET THE REQUIREMENTS FOR PARTICIPATION. THE SECOND PART OF THIS CLEARANCE COVERS RECORDKEEPING REQUIREMENTS IMPOSED ON THE PLANS THAT PARTICIPATE IN THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM FOR THE PURPOSE OF CONTRACT AUDITING AND MONITORING.
None
None
No
  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 49 0 0 0 49 0
Annual Time Burden (Hours) 13,530 7,050 0 0 6,480 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
03/23/1995