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Federal forms, ICRs, and supporting documents

Information Collection Request

Application to Participate as a Carrier of a Comprehensive Medical Plan in the Federal Employees Health Benefits Program

ICR 199612-3206-001 · 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
33620 Application to Participate as a Carrier of a Comprehensive Medical Plan in the Federal Employees Health Benefits Program Migrated
ICR Details
3206-0145 199612-3206-001
Historical Active 199503-3206-004
OPM
Application to Participate as a Carrier of a Comprehensive Medical Plan in the Federal Employees Health Benefits Program
Revision of a currently approved collection   No
Regular
Approved without change 01/31/1997
Retrieve Notice of Action (NOA) 12/04/1996
  Inventory as of this Action Requested Previously Approved
01/31/2000 01/31/2000 06/30/1998
50 0 49
4,500 0 13,530
101,000 0 0
This information collection is used by OPM to determine if organizations applying for participation in the Federal Employees Health Benefits Program as carriers of comprehensive medical plans meet the requirements for participation.
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 50 49 0 1 0 0
Annual Time Burden (Hours) 4,500 13,530 0 -9,030 0 0
Annual Cost Burden (Dollars) 101,000 0 0 0 101,000 0
No
Yes
$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.
12/04/1996