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Department of Health and Human Services
Food and Drug Administration
OMB NO: 0910-0001    EXPIRATION DATE: 05/31/2008
RESPS:42,878         HOURS:2,372,556      COSTS(000):$0
  FDA Approval to Market a New Drug
FORMS: FDA-2252 FDA-2253 FDA-3331

OMB NO: 0910-0014    EXPIRATION DATE: 05/31/2009
RESPS:1,277,517      HOURS:71,369,525     COSTS(000):$0
  Investigational New Drug Regulations
FORMS: 1571 1572

OMB NO: 0910-0016    EXPIRATION DATE: 11/30/2006
RESPS:13             HOURS:31,385         COSTS(000):$560
  Submission of Petitions: Food Additive, Color Additive
  (Including Labeling), and Generally Recognized as Safe
  Affirmation; and Electronic Submission Using FDA Forms 3503 and
  3504
FORMS: FDA-3503 FDA-3504

OMB NO: 0910-0021    EXPIRATION DATE: 11/30/2006
RESPS:62             HOURS:211            COSTS(000):$0
  Interstate Shellfish Dealer's Certificate
FORMS: FDA-3038

OMB NO: 0910-0025    EXPIRATION DATE: 12/31/2006
RESPS:47,343         HOURS:324,957        COSTS(000):$0
  Reporting and Recordkeeping for Electronic Products - General
  Requirements
FORMS: FDA-2579 2767 2877 3147

OMB NO: 0910-0027    EXPIRATION DATE: 11/30/2007
RESPS:15             HOURS:6              COSTS(000):$0
  Voluntary Registration of Cosmetics Product Establishment
FORMS: FDA-2511

OMB NO: 0910-0030    EXPIRATION DATE: 12/31/2008
RESPS:1,503          HOURS:742            COSTS(000):$0
  Cosmetic Product Voluntary Reporting Program - 21 CFR Part 720
FORMS: 2512 2512A 2514

OMB NO: 0910-0032    EXPIRATION DATE: 12/31/2007
RESPS:1,406          HOURS:340,858        COSTS(000):$0
  New Animal Drug Application, 21 CFR Part 514
FORMS: 356V

OMB NO: 0910-0037    EXPIRATION DATE: 06/30/2008
RESPS:17,586         HOURS:1,985,108      COSTS(000):$0
  Food Canning Establishment Registration, Process Filing and
  Recordkeeping for Acidified and Thermally Processed Low-Acid
  Foods
FORMS: 2541 2541A 2541C

OMB NO: 0910-0045    EXPIRATION DATE: 12/31/2007
RESPS:75,687         HOURS:189,217        COSTS(000):$0
  Registration of Producers of Drugs and Listing of Drugs in
  Commercial Distribution
FORMS: NONE

OMB NO: 0910-0046    EXPIRATION DATE: 05/31/2009
RESPS:3,709,134      HOURS:519,279        COSTS(000):$0
  Electronic Importer's Entry Notice
FORMS: NONE

OMB NO: 0910-0052    EXPIRATION DATE: 03/31/2009
RESPS:2,875          HOURS:1,533          COSTS(000):$0
  Blood Establishment Registration and Product Lising Form FDA 2830
FORMS: FDA-2830

OMB NO: 0910-0053    EXPIRATION DATE: 02/29/2008
RESPS:340            HOURS:2,142          COSTS(000):$0
  Radioactive Drug Research Committee (RDRC) Report on Research
  Use of Radioactive Drug Study Summary
FORMS: FDA-2914 FDA-2915

OMB NO: 0910-0073    EXPIRATION DATE: 09/30/2007
RESPS:8,254          HOURS:2,833,020      COSTS(000):$1,182
  Current Good Manufacturing Practice (CGMP); Quality System (QS)
  Regulation
FORMS: NONE

OMB NO: 0910-0078    EXPIRATION DATE: 11/30/2006
RESPS:4,527          HOURS:61,021         COSTS(000):$0
  Investigational Device Exemptions Reports and Records - 21 CFR
  812
FORMS: NONE

OMB NO: 0910-0114    EXPIRATION DATE: 11/30/2006
RESPS:26             HOURS:461            COSTS(000):$0
  Administrative Detention and Banned Medical Devices
FORMS: NONE

OMB NO: 0910-0116    EXPIRATION DATE: 12/31/2008
RESPS:530,829        HOURS:564,678        COSTS(000):$0
  Current Good Manufacturing Practices for Blood and Related
  Regulations for and Blood Components
FORMS: NONE

OMB NO: 0910-0117    EXPIRATION DATE: 06/30/2008
RESPS:4,527          HOURS:34,622         COSTS(000):$0
  New Animal Drugs for Investigational Use
FORMS: 3458

OMB NO: 0910-0119    EXPIRATION DATE: 04/30/2008
RESPS:36,150         HOURS:1,311,157      COSTS(000):$0
  Good Laboratory Practice (GLP) Regulations for Nonclinical
  Laboratory Studies - 21 CFR Part 58
FORMS: NONE

OMB NO: 0910-0120    EXPIRATION DATE: 05/31/2007
RESPS:26,100         HOURS:359,000        COSTS(000):$0
  Premarket Notification Submission 5100(k), Subpart E
FORMS: 3514

OMB NO: 0910-0130    EXPIRATION DATE: 11/30/2007
RESPS:73,000         HOURS:7,300,000      COSTS(000):$0
  Protection of Human Subjects; Recordkeeping Requirements for
  Institutional Review Boards (IRBs)
FORMS: NONE

OMB NO: 0910-0131    EXPIRATION DATE: 11/30/2006
RESPS:1,800          HOURS:8,100          COSTS(000):$0
  Agreement for Shipments of Devices for Sterilization
FORMS: NONE

OMB NO: 0910-0133    EXPIRATION DATE: 07/31/2008
RESPS:14             HOURS:166            COSTS(000):$0
  Temporary Marketing Permit Applications
FORMS: NONE

OMB NO: 0910-0138    EXPIRATION DATE: 03/31/2009
RESPS:6              HOURS:3,000          COSTS(000):$0
  Reclassification Petitions for Medical Devices
FORMS: FDA-3427 FDA-3428 FDA-3429

OMB NO: 0910-0139    EXPIRATION DATE: 09/30/2008
RESPS:1,174,427      HOURS:798,132        COSTS(000):$0
  Current Good Manufacturing Practice; Proposed Amendment of
  Certain Requirements for Finished Pharmaceuticals
FORMS: NONE

OMB NO: 0910-0152    EXPIRATION DATE: 12/31/2007
RESPS:36,444,150     HOURS:7,315,661      COSTS(000):$0
  Current Good Manufacturing Practice Regulations for Medicated
  Feed, 21 CFR Part 225
FORMS: NONE

OMB NO: 0910-0154    EXPIRATION DATE: 12/31/2007
RESPS:180,550        HOURS:157,550        COSTS(000):$0
  Good Manufacturing Practice Regulations for Type A Medicated
  Articles, 21 CFR Part 226
FORMS: NONE

OMB NO: 0910-0167    EXPIRATION DATE: 07/31/2007
RESPS:1              HOURS:37,343         COSTS(000):$0
  Orphan Drug Products
FORMS: NONE

OMB NO: 0910-0183    EXPIRATION DATE: 04/30/2009
RESPS:516            HOURS:6,108          COSTS(000):$0
  General Administrative Procedures: Citizen Petitions; Petition
  for Reconsideration or Stay of Action; Advisory Opinions
FORMS: NONE

OMB NO: 0910-0184    EXPIRATION DATE: 05/31/2009
RESPS:10             HOURS:200            COSTS(000):$0
  Filing Objections and Requests for a Hearing on a Regulation or
  Order
FORMS: NONE

OMB NO: 0910-0186    EXPIRATION DATE: 06/30/2009
RESPS:720            HOURS:720            COSTS(000):$0
  Irradiation in the Production, Processing and Handling of Food
FORMS: NONE

OMB NO: 0910-0188    EXPIRATION DATE: 07/31/2008
RESPS:1              HOURS:12,854         COSTS(000):$0
  Infant Formula Recall Regulations
FORMS: NONE

OMB NO: 0910-0191    EXPIRATION DATE: 05/31/2009
RESPS:1              HOURS:792            COSTS(000):$0
  Notice of Participation - 21 CFR 12.45
FORMS: NONE

OMB NO: 0910-0206    EXPIRATION DATE: 08/31/2006
RESPS:6,747          HOURS:20,588         COSTS(000):$0
  Request for Samples and Protocols
FORMS: NONE

OMB NO: 0910-0212    EXPIRATION DATE: 12/31/2008
RESPS:1,626          HOURS:2,425          COSTS(000):$0
  Regulations Under the Federal Import Milk Act (21 CFR Part 1210)
  (formerly Federal Import Milk Act)
FORMS: 1815 1993 1994 1995 1996 1997

OMB NO: 0910-0216    EXPIRATION DATE: 11/30/2007
RESPS:4,603          HOURS:2,302          COSTS(000):$0
  Color Additive Requests and Recordkeeping
FORMS: NONE

OMB NO: 0910-0230    EXPIRATION DATE: 04/30/2009
RESPS:410,645        HOURS:7,037,246      COSTS(000):$1,416
  Adverse Drug Experience Reporting
FORMS: NONE

OMB NO: 0910-0231    EXPIRATION DATE: 09/30/2007
RESPS:581            HOURS:113,464        COSTS(000):$0
  Premarket Approval of Medical Devices - 21 CFR Part 814
FORMS: NONE

OMB NO: 0910-0233    EXPIRATION DATE: 11/30/2007
RESPS:9              HOURS:800            COSTS(000):$0
  Patent Term Restoration
FORMS: NONE

OMB NO: 0910-0249    EXPIRATION DATE: 10/31/2008
RESPS:16,625         HOURS:201,875        COSTS(000):$0
  FDA Recall Regulations
FORMS: NONE

OMB NO: 0910-0256    EXPIRATION DATE: 03/31/2007
RESPS:40             HOURS:25,968         COSTS(000):$0
  Infant Formula Requirements
FORMS: NONE

OMB NO: 0910-0264    EXPIRATION DATE: 11/30/2006
RESPS:20             HOURS:50             COSTS(000):$0
  Export of Medical Devices - Foreign Letters of Approval
FORMS: NONE

OMB NO: 0910-0275    EXPIRATION DATE: 11/30/2008
RESPS:1              HOURS:10             COSTS(000):$0
  State Enforcement Notification (21 CFR 100.2(d))
FORMS: NONE

OMB NO: 0910-0277    EXPIRATION DATE: 06/30/2008
RESPS:1              HOURS:40             COSTS(000):$0
  State Petitions for Exemption from Preemption
FORMS: NONE

OMB NO: 0910-0284    EXPIRATION DATE: 09/30/2006
RESPS:45,528         HOURS:138,114        COSTS(000):$0
  Records and Reports Concerning Experience with Approved New
  Animal Drugs
FORMS: 1932 1932A 2301

OMB NO: 0910-0291    EXPIRATION DATE: 10/31/2008
RESPS:488,403        HOURS:523,118        COSTS(000):$0
  MedWatch: The FDA Medical Products Reporting Program
FORMS: FDA-3500 3500A

OMB NO: 0910-0297    EXPIRATION DATE: 12/31/2006
RESPS:3,231          HOURS:969            COSTS(000):$0
  User Fee Cover Sheet
FORMS: 3397

OMB NO: 0910-0298    EXPIRATION DATE: 03/31/2007
RESPS:6              HOURS:288            COSTS(000):$0
  Food Additives; Threshold of Regulation for Substances Used in
  Food-Contact Articles
FORMS: NONE

OMB NO: 0910-0302    EXPIRATION DATE: 05/31/2007
RESPS:62             HOURS:592,166        COSTS(000):$0
  Human Tissue Intended for Transplantation
FORMS: NONE

OMB NO: 0910-0303    EXPIRATION DATE: 07/31/2008
RESPS:4,500          HOURS:270,000        COSTS(000):$0
  Electronic Records: Electronic Signatures
FORMS: NONE

OMB NO: 0910-0308    EXPIRATION DATE: 07/31/2008
RESPS:22,324         HOURS:493,522        COSTS(000):$0
  Adverse Experience Reporting for Licensed Biological Product;
  and General Records
FORMS: NONE

OMB NO: 0910-0309    EXPIRATION DATE: 03/31/2007
RESPS:36,000,000     HOURS:3,219,936      COSTS(000):$19,491
  Mammography Facilities, Standards, and Lay Summaries for Patients
FORMS: FDA-3422

OMB NO: 0910-0320    EXPIRATION DATE: 09/30/2007
RESPS:191            HOURS:553            COSTS(000):$0
  Request for Information from U.S. Processors that Export to the
  European Community
FORMS: NONE

OMB NO: 0910-0322    EXPIRATION DATE: 12/31/2006
RESPS:10,748         HOURS:210,182        COSTS(000):$0
  21 CFR 25-Enviornmental Impact Considerations
FORMS: NONE

OMB NO: 0910-0325    EXPIRATION DATE: 11/30/2008
RESPS:2              HOURS:8,320          COSTS(000):$0
  Extralabel Drug Use in Animals
FORMS: NONE

OMB NO: 0910-0330    EXPIRATION DATE: 07/31/2008
RESPS:71             HOURS:1,420          COSTS(000):$0
  Premarket Notification for a New Dietary Ingredient
FORMS: NONE

OMB NO: 0910-0331    EXPIRATION DATE: 12/31/2006
RESPS:2,500          HOURS:1,875          COSTS(000):$0
  Food Labeling: Notification Procedures for Statements on Dietary
  Supplements
FORMS: NONE

OMB NO: 0910-0332    EXPIRATION DATE: 12/31/2008
RESPS:108            HOURS:10,038         COSTS(000):$0
  Medical Devices; Humanitarian Use Devices; 21 CFR Part 814 -
  Subpart H
FORMS: NONE

OMB NO: 0910-0337    EXPIRATION DATE: 12/31/2006
RESPS:1,292          HOURS:71             COSTS(000):$0
  Medicated Fee Mill License Application
FORMS: 3448

OMB NO: 0910-0338    EXPIRATION DATE: 09/30/2008
RESPS:14,613         HOURS:335,088        COSTS(000):$0
  General Licensing Provisions: Biologics License Application,
  Changes to an Approved Application, Labeling, Revocation and
  Suspension, and Forms FDA 356h & 2567
FORMS: FDA-2567 FDA-356H

OMB NO: 0910-0339    EXPIRATION DATE: 05/31/2007
RESPS:400            HOURS:5,600          COSTS(000):$0
  Substances Prohibited from Use in Animal Food or Feed; Animal
  Proteins Prohibited in Ruminant Feed
FORMS: NONE

OMB NO: 0910-0340    EXPIRATION DATE: 06/30/2008
RESPS:39,932         HOURS:120,578        COSTS(000):$0
  Over-the-Counter Human Drugs; Labeling Requirements
FORMS: NONE

OMB NO: 0910-0341    EXPIRATION DATE: 10/31/2006
RESPS:924            HOURS:157            COSTS(000):$0
  FDA Safety Alert/Public Health Advisory Readership Survey
FORMS: NONE

OMB NO: 0910-0342    EXPIRATION DATE: 05/31/2009
RESPS:60             HOURS:9,900          COSTS(000):$0
  Substances Generally Recognized as Safe: Notification Procedure
FORMS: NONE

OMB NO: 0910-0345    EXPIRATION DATE: 09/30/2008
RESPS:1              HOURS:1,401          COSTS(000):$0
  2005 Food Safety Survey
FORMS: NONE

OMB NO: 0910-0354    EXPIRATION DATE: 12/31/2006
RESPS:5,850          HOURS:627,075        COSTS(000):$9,406
  Procedures for the Safe Processing and Importing of Fish and
  Fishery Products; 21 CFR Part 123
FORMS: NONE

OMB NO: 0910-0356    EXPIRATION DATE: 03/31/2007
RESPS:860            HOURS:544,036        COSTS(000):$0
  Substantial Evidence of Effectiveness of New Animal Drugs
FORMS: NONE

OMB NO: 0910-0359    EXPIRATION DATE: 04/30/2008
RESPS:625            HOURS:6,250          COSTS(000):$0
  Medical Devices; Reports of Corrections and Removals
FORMS: NONE

OMB NO: 0910-0360    EXPIRATION DATE: 05/31/2008
RESPS:6,000          HOURS:1,800          COSTS(000):$0
  Customer/Partner Service Surveys - (Extension)
FORMS: NONE

OMB NO: 0910-0363    EXPIRATION DATE: 11/30/2008
RESPS:1,880,521      HOURS:120,184        COSTS(000):$0
  Veterinary Feed Directive
FORMS: NONE

OMB NO: 0910-0370    EXPIRATION DATE: 09/30/2007
RESPS:557            HOURS:1,762          COSTS(000):$0
  Specific Requirements on the Content and Format of Labeling for
  Human Prescription Drugs; Addition of Geriatric Use Subsection
FORMS: NONE

OMB NO: 0910-0374    EXPIRATION DATE: 09/30/2008
RESPS:3              HOURS:1,153          COSTS(000):$0
  Guidance for Industry: Notification of a Health Claim or
  Nutrient Content Claim Based on an Authoritative Statement of a
  Scientific Body
FORMS: NONE

OMB NO: 0910-0375    EXPIRATION DATE: 12/31/2007
RESPS:11             HOURS:10,860         COSTS(000):$0
  Medical Devices; Third Party Review Under FDAMA
FORMS: NONE

OMB NO: 0910-0378    EXPIRATION DATE: 04/30/2008
RESPS:210            HOURS:14,622         COSTS(000):$0
  Medical Devices, Third Party Premarket Submission Review and
  Quality System Inspections Under U.S./E.C. MRA
FORMS: NONE

OMB NO: 0910-0381    EXPIRATION DATE: 05/31/2007
RESPS:509,579        HOURS:1,594,269      COSTS(000):$16,800
  Food Labeling Regulations
FORMS: NONE

OMB NO: 0910-0387    EXPIRATION DATE: 04/30/2008
RESPS:1              HOURS:41,850         COSTS(000):$0
  Medical Devices Registration and Listing
FORMS: 2891 2891A 2892

OMB NO: 0910-0389    EXPIRATION DATE: 08/31/2008
RESPS:114            HOURS:8,720          COSTS(000):$0
  Guidance for Industry: Fast Track Drug Development Programs -
  Designation, Development, and Application Review
FORMS: NONE

OMB NO: 0910-0390    EXPIRATION DATE: 12/31/2008
RESPS:157            HOURS:2,114          COSTS(000):$0
  Dissemination of Information on Unapproval/New Uses for Marketed
  Drugs, Biologics, and Devices
FORMS: NONE

OMB NO: 0910-0393    EXPIRATION DATE: 08/31/2008
RESPS:1,100,000      HOURS:4,248          COSTS(000):$0
  Prescription Drug Product Labeling; Medication Guide Requirements
FORMS: NONE

OMB NO: 0910-0396    EXPIRATION DATE: 04/30/2009
RESPS:1              HOURS:18,750         COSTS(000):$0
  Financial Disclosure by Clinical Investigators
FORMS: 3454 3455

OMB NO: 0910-0409    EXPIRATION DATE: 10/31/2008
RESPS:2              HOURS:4,000          COSTS(000):$0
  Regs. for In Vivo Radiopharmaceuticals Used for Diagnosis nd
  Monitoring - Final Rule
FORMS: NONE

OMB NO: 0910-0428    EXPIRATION DATE: 01/31/2009
RESPS:25             HOURS:25             COSTS(000):$0
  Record Retention Requirements for the Soy Protein/CHD Health
  Claim
FORMS: NONE

OMB NO: 0910-0429    EXPIRATION DATE: 03/31/2009
RESPS:3,642          HOURS:49,004         COSTS(000):$0
  Guidance for Industry on Formal Meetings with Sponsors and
  Applicants for PDUFA Products
FORMS: 1571 1572 356H

OMB NO: 0910-0430    EXPIRATION DATE: 04/30/2009
RESPS:11             HOURS:88             COSTS(000):$0
  Guidance for Industry on Formal Dispute Resolutions; Appeals
  Above the Division Level
FORMS: 1571 356H

OMB NO: 0910-0432    EXPIRATION DATE: 02/28/2009
RESPS:2              HOURS:1,082          COSTS(000):$0
  Medical Device Recall Authority
FORMS: NONE

OMB NO: 0910-0433    EXPIRATION DATE: 03/31/2007
RESPS:65             HOURS:1,560          COSTS(000):$0
  Postmarketing Studies for Human Drugs and Licensed Biological
  Products; Status Report
FORMS: NONE

OMB NO: 0910-0435    EXPIRATION DATE: 08/31/2006
RESPS:102,261,312    HOURS:10,634,432     COSTS(000):$0
  Prescription Drug Marketing Act of 1987; Policies, Requirements,
  and Administrative Procedures
FORMS: NONE

OMB NO: 0910-0437    EXPIRATION DATE: 05/31/2009
RESPS:122,325        HOURS:138,271        COSTS(000):$0
  Medical Devices; Medical Device Reporting; Manufacturer
  reporting; importer reporting, user facility reporting,
  distributor reporting
FORMS: FDA-3417 FDA-3419

OMB NO: 0910-0439    EXPIRATION DATE: 07/31/2009
RESPS:10             HOURS:140            COSTS(000):$0
  Aluminum in Large and Small Volume Parenterals Used in Total
  Parenteral Nutrition
FORMS: NONE

OMB NO: 0910-0442    EXPIRATION DATE: 04/30/2008
RESPS:1,481,939      HOURS:3,407,184      COSTS(000):$0
  Medical Devices; Device Tracking (Amended)
FORMS: NONE

OMB NO: 0910-0445    EXPIRATION DATE: 12/31/2006
RESPS:164            HOURS:46,576         COSTS(000):$0
  Guidance for Industry: Submitting and Reviewing Complete
  Responses to Clinical Holds
FORMS: NONE

OMB NO: 0910-0448    EXPIRATION DATE: 01/31/2007
RESPS:600            HOURS:600            COSTS(000):$0
  Adoption of FDA Food Code by Local, State and Tribal Governments
FORMS: NONE

OMB NO: 0910-0449    EXPIRATION DATE: 12/31/2006
RESPS:138            HOURS:5,778          COSTS(000):$0
  Postmarket Surveillance of Medical Devices
FORMS: NONE

OMB NO: 0910-0450    EXPIRATION DATE: 02/28/2007
RESPS:84             HOURS:33             COSTS(000):$0
  Guidance for Industry on How to Use E-Mail to Submit a Notice of
  Intent to Slaughter for Human Food Purposes
FORMS: FDA-3488

OMB NO: 0910-0452    EXPIRATION DATE: 03/31/2007
RESPS:168            HOURS:116            COSTS(000):$0
  Guidance for Indusry on How to Use E-Mail to Submit a Request
  for a Meeting or Teleconference to the Office of New Animal Drug
  Evaluation
FORMS: 3489

OMB NO: 0910-0453    EXPIRATION DATE: 02/28/2007
RESPS:324            HOURS:262            COSTS(000):$0
  Guidance for Industry on How to Use E-Mail to Submit a Notice of
  Final Disposition of Animals Not Intended for Immediate Slaughter
FORMS: FDA-3487

OMB NO: 0910-0454    EXPIRATION DATE: 03/31/2007
RESPS:140            HOURS:70             COSTS(000):$0
  Guidance for Industry on How to Use E-Mail Submit Information to
  the Center for Veterinary Medicine
FORMS: 3538

OMB NO: 0910-0456    EXPIRATION DATE: 12/31/2006
RESPS:50             HOURS:156            COSTS(000):$0
  Infectious Disease Issues in Xenotransplantation
FORMS: NONE

OMB NO: 0910-0458    EXPIRATION DATE: 03/31/2007
RESPS:33,922         HOURS:67,844         COSTS(000):$0
  Biological Products: Reporting of Biological Product Deviations
  in Manufacturing
FORMS: 3486

OMB NO: 0910-0459    EXPIRATION DATE: 05/31/2007
RESPS:38,514         HOURS:177,165        COSTS(000):$0
  Information Program on Clinical Trials for Serious and
  Life-Threatening Diseases: Maintaining a Databank
FORMS: NONE

OMB NO: 0910-0466    EXPIRATION DATE: 07/31/2007
RESPS:15,035         HOURS:360,930        COSTS(000):$0
  Hazard Analysis and Critical Control Point (HACCP) Procedures
  for the Safe and Sanitary Processing of Juice (21 CFR Part 120)
FORMS: NONE

OMB NO: 0910-0469    EXPIRATION DATE: 07/31/2007
RESPS:1,370          HOURS:1,005          COSTS(000):$0
  Human Cells, Tissues, and Cellular and Tissue-Based Products;
  Establishment Registration and Listing
FORMS: FDA-3356

OMB NO: 0910-0470    EXPIRATION DATE: 09/30/2007
RESPS:334            HOURS:4,723          COSTS(000):$0
  Special Protocol Assessment Guidance
FORMS: NONE

OMB NO: 0910-0471    EXPIRATION DATE: 09/30/2007
RESPS:2,800          HOURS:2,772          COSTS(000):$0
  Adverse Event Pilot Program for Medical Devices
FORMS: NONE

OMB NO: 0910-0482    EXPIRATION DATE: 06/30/2008
RESPS:2,065          HOURS:43,214         COSTS(000):$0
  Exports: Notification and Recordkeeping Requirements
FORMS: NONE

OMB NO: 0910-0485    EXPIRATION DATE: 06/30/2008
RESPS:2,320,385      HOURS:3,503,120      COSTS(000):$0
  Medical Device Labeling Regulations
FORMS: NONE

OMB NO: 0910-0491    EXPIRATION DATE: 05/31/2009
RESPS:195            HOURS:98             COSTS(000):$0
  Emergency Shortages Data Collection System (formerly Emergency
  Medical Device Shortage Program Survey)
FORMS: NONE

OMB NO: 0910-0495    EXPIRATION DATE: 12/31/2008
RESPS:126            HOURS:15,985         COSTS(000):$23,500
  Food Additives; Food Contact Substances Notification System
FORMS: 3479 3480

OMB NO: 0910-0497    EXPIRATION DATE: 11/30/2007
RESPS:2,574          HOURS:4,252          COSTS(000):$0
  Focus Groups as Used by the Food and Drug Administration
FORMS: NONE

OMB NO: 0910-0498    EXPIRATION DATE: 03/31/2009
RESPS:14,213         HOURS:21,170         COSTS(000):$0
  Export Certificates for FDA Regulated Products under U.S.C.
  Sections 801(e) and 802
FORMS: 3613 3613A 3613B 3613C 3613D 3613E

OMB NO: 0910-0500    EXPIRATION DATE: 11/30/2007
RESPS:6,000          HOURS:3,000          COSTS(000):$0
  Generic FDA Rapid Response Surveys
FORMS: NONE

OMB NO: 0910-0502    EXPIRATION DATE: 10/31/2006
RESPS:421,361        HOURS:521,831        COSTS(000):$0
  Registration of Food Facilities Under the Public Health Security
  and Bioterrorism Preparedness and Response Act of 2002
FORMS: FDA-3537 FDA-3537A

OMB NO: 0910-0508    EXPIRATION DATE: 12/31/2006
RESPS:3,000          HOURS:3,000          COSTS(000):$0
  FY 2003 MDUFMA Small Business Qualification Certification (Form
  FDA 3602)
FORMS: 3602

OMB NO: 0910-0509    EXPIRATION DATE: 12/31/2006
RESPS:50             HOURS:150            COSTS(000):$0
  Establishing a List of U.S. Dairy Producers for Export to Chile
FORMS: NONE

OMB NO: 0910-0510    EXPIRATION DATE: 11/30/2006
RESPS:25             HOURS:2,550          COSTS(000):$0
  Medical Devices; Inspection by Accredited Persons Program Under
  the Medical Device User Fee and Modernization Act of 2002
  (MDUFMA)
FORMS: NONE

OMB NO: 0910-0511    EXPIRATION DATE: 11/30/2006
RESPS:5,000          HOURS:1,500          COSTS(000):$0
  Medical Device User Fee Cover Sheet - FDA Form 3601
FORMS: FDA-3601

OMB NO: 0910-0513    EXPIRATION DATE: 10/31/2006
RESPS:481            HOURS:499,805        COSTS(000):$0
  Applications for FDA Approval to Market a New Drug: Patient
  Listing Requirements and Application of 30-month Stays on
  Approval of Abbreviated New Drug Applications Certifying That...
FORMS: 3542 3542(A)

OMB NO: 0910-0515    EXPIRATION DATE: 11/30/2006
RESPS:307,600        HOURS:615,200        COSTS(000):$171,700
  Food Labeling: Trans Fatty Acids in Nutrition Labeling
FORMS: NONE

OMB NO: 0910-0516    EXPIRATION DATE: 10/31/2006
RESPS:5,000          HOURS:1,500          COSTS(000):$0
  Impact of Risk Management Programs on the Practice of Pharmacy -
  Survey
FORMS: NONE

OMB NO: 0910-0518    EXPIRATION DATE: 06/30/2007
RESPS:125            HOURS:10,000         COSTS(000):$0
  Guidance for Industry: Continuous Marketing Applications: Pilot
  2 Scientific Feedback and Interactions During Development of
  Fast Track Products Under PDUFA
FORMS: NONE

OMB NO: 0910-0519    EXPIRATION DATE: 09/30/2007
RESPS:120            HOURS:480            COSTS(000):$0
  Control of Communicable Diseases; Requests for Exemptions from
  the Restrictions on African Rodents, Prairie Dogs, and Certain
  Other Animals
FORMS: NONE

OMB NO: 0910-0520    EXPIRATION DATE: 10/31/2006
RESPS:6,891,625      HOURS:2,836,781      COSTS(000):$6,268
  Prior Notice of Imported Food Shipments
FORMS: 3540

OMB NO: 0910-0521    EXPIRATION DATE: 01/31/2007
RESPS:5              HOURS:70,550         COSTS(000):$0
  Assessment of the Effects of Antimicrobial Drug Residues from
  Food of Animal Origin on the Human Intestinal Flora
FORMS: NONE

OMB NO: 0910-0523    EXPIRATION DATE: 02/28/2007
RESPS:28             HOURS:672            COSTS(000):$0
  Product Jurisdiction: Assignment of Agency Component for Review
  of Premarket Applications
FORMS: NONE

OMB NO: 0910-0524    EXPIRATION DATE: 02/28/2007
RESPS:100            HOURS:20             COSTS(000):$0
  Draft Guidance for Industry: How to Use E-Mail to Submit a Study
  Protocol
FORMS: 3536

OMB NO: 0910-0528    EXPIRATION DATE: 03/31/2007
RESPS:1,158          HOURS:579            COSTS(000):$0
  Guidance for Industry - Reports on the Status of Postmarketing
  Studies - Implementation of Section 130 of the Food and Drug
  Administration Modernization Act of 1997
FORMS: NONE

OMB NO: 0910-0530    EXPIRATION DATE: 11/30/2006
RESPS:9,200          HOURS:52,344         COSTS(000):$0
  Requirements for Submission of Labeling for Human Prescription
  Drugs and Biologics in Electronic Format
FORMS: NONE

OMB NO: 0910-0537    EXPIRATION DATE: 02/28/2007
RESPS:41,753,827     HOURS:1,777,550      COSTS(000):$0
  Bar Code Label Requirements for Human Drug Products and
  Biological Products (Final Rule)
FORMS: NONE

OMB NO: 0910-0538    EXPIRATION DATE: 03/31/2007
RESPS:31,555         HOURS:1,023,310      COSTS(000):$0
  Supplements and Other Changes to an Approved Application - Final
  Rule
FORMS: NONE

OMB NO: 0910-0539    EXPIRATION DATE: 12/31/2007
RESPS:69             HOURS:69             COSTS(000):$0
  Animal Drug User Fee Cover Sheet
FORMS: 3546

OMB NO: 0910-0540    EXPIRATION DATE: 12/31/2007
RESPS:30             HOURS:60             COSTS(000):$0
  Guidance for Industry: Animal Drug User Fees and Fee Waivers and
  Reductions
FORMS: NONE

OMB NO: 0910-0541    EXPIRATION DATE: 06/30/2007
RESPS:147            HOURS:147            COSTS(000):$0
  Preparing a Claim of Categorical Exclusion or an Environmental
  Assessment for Submission to the Center for Food Safety and
  Applied Nutrition
FORMS: NONE

OMB NO: 0910-0543    EXPIRATION DATE: 05/31/2007
RESPS:1,274,272      HOURS:866,240        COSTS(000):$0
  Eligibility Determination for Donors of Human Cells, Tissues,
  and Cellular and Tissue-Based Products (HCT/Ps)
FORMS: NONE

OMB NO: 0910-0545    EXPIRATION DATE: 09/30/2007
RESPS:4,600          HOURS:1,083          COSTS(000):$0
  Health and Diet Survey -- 2004 Supplement
FORMS: NONE

OMB NO: 0910-0546    EXPIRATION DATE: 11/30/2006
RESPS:6              HOURS:13,000         COSTS(000):$0
  Food Additive Petitions, 21 CFR Part 571, Center for Veterinary
  Medicine
FORMS: NONE

OMB NO: 0910-0548    EXPIRATION DATE: 08/31/2006
RESPS:1              HOURS:71             COSTS(000):$0
  Requirements for Collection of Data Relating to the Prevention
  of Medical Gas Mix-ups at Health Care Facilities Survey
FORMS: NONE

OMB NO: 0910-0549    EXPIRATION DATE: 06/30/2008
RESPS:1              HOURS:1              COSTS(000):$0
  Irradiation in the Production, Processing and Handling of Food
FORMS: NONE

OMB NO: 0910-0551    EXPIRATION DATE: 02/29/2008
RESPS:100            HOURS:100            COSTS(000):$0
  Application for Participation in the Medical Device Fellowship
  Program; Form FDA 3608
FORMS: FDA-3608

OMB NO: 0910-0553    EXPIRATION DATE: 10/31/2007
RESPS:1,742          HOURS:34,840         COSTS(000):$0
  Use of Symbols on Labels and in Labeling of In Vitro Diagnostic
  Devices Intended for Professional Use
FORMS: NONE

OMB NO: 0910-0555    EXPIRATION DATE: 11/30/2007
RESPS:190            HOURS:27,740         COSTS(000):$0
  SPresubmission Conferences - Final Rule
FORMS: NONE

OMB NO: 0910-0557    EXPIRATION DATE: 12/31/2007
RESPS:80             HOURS:6,400          COSTS(000):$0
  Guidance for Industry - Pharmacogenomic Data Submissions
FORMS: NONE

OMB NO: 0910-0558    EXPIRATION DATE: 12/31/2007
RESPS:15,978         HOURS:7,669          COSTS(000):$0
  Infant Feeding Practices Study II
FORMS: NONE

OMB NO: 0910-0559    EXPIRATION DATE: 11/30/2007
RESPS:23,731         HOURS:283,400        COSTS(000):$0
  Current Good Tissue Practice for Human Cell, Tissue, and
  Cellular and Tissue-Based Product Establishments; Inspection and
  Enforcement
FORMS: NONE

OMB NO: 0910-0560    EXPIRATION DATE: 02/29/2008
RESPS:707,672        HOURS:5,359,000      COSTS(000):$6,646
  Recordkeeping and Records Access Requirements for Food Facilities
FORMS: NONE

OMB NO: 0910-0562    EXPIRATION DATE: 05/31/2008
RESPS:652            HOURS:2,998          COSTS(000):$32
  Channels of Trade Policy for Commodities with Residues of
  Pesticide Chemicals for Which Tolerances Have Been Rovoked,
  Suspended, or Modified by the EPA
FORMS: NONE

OMB NO: 0910-0563    EXPIRATION DATE: 05/31/2008
RESPS:30             HOURS:790            COSTS(000):$0
  Guidance for Industry: Formal Dispute Resolution; Scientific and
  Technical Issues Related to Pharmaceutical Current Good
  Manufacturing Practice
FORMS: NONE

OMB NO: 0910-0564    EXPIRATION DATE: 05/31/2008
RESPS:300            HOURS:54,000         COSTS(000):$0
  Performance Standard for Diagnostic X-Ray Systems and Their
  Major Components
FORMS: NONE

OMB NO: 0910-0565    EXPIRATION DATE: 08/31/2008
RESPS:2,880          HOURS:1,827          COSTS(000):$0
  Experimental Study of Health Claims on Food Packages
FORMS: NONE

OMB NO: 0910-0566    EXPIRATION DATE: 06/30/2008
RESPS:2              HOURS:60             COSTS(000):$0
  Dispute Resolution Procedures for Science Based Decisions on
  Products Regulated by the CVM
FORMS: NONE

OMB NO: 0910-0567    EXPIRATION DATE: 07/31/2008
RESPS:5,060          HOURS:845            COSTS(000):$0
  Allergen Labeling of Food Products Consumer Preference Survey
  and Experimental Study on Allergen Labeling of Food Products
FORMS: NONE

OMB NO: 0910-0569    EXPIRATION DATE: 08/31/2008
RESPS:15             HOURS:1,500          COSTS(000):$0
  Requests for Inspection by an Accredited Person under the
  Inspection by Accredited Persons Program
FORMS: NONE

OMB NO: 0910-0570    EXPIRATION DATE: 12/31/2008
RESPS:10,000         HOURS:2,731          COSTS(000):$0
  Experimental Study of Carbohydrate Content Claims on Food Labels
FORMS: NONE

OMB NO: 0910-0571    EXPIRATION DATE: 05/31/2008
RESPS:900            HOURS:4,500          COSTS(000):$0
  Guidance for Requesting an Extension to Use Existing Label Stock
  After The Trans Fat Labeling Effective Date of January 1, 2006
FORMS: NONE

OMB NO: 0910-0572    EXPIRATION DATE: 01/31/2009
RESPS:1,911          HOURS:501,383        COSTS(000):$0
  Requirements on Content and Format of Labeling for Human
  Prescription Drug and Biological Products, Final Rule
FORMS: NONE

OMB NO: 0910-0575    EXPIRATION DATE: 01/31/2009
RESPS:18             HOURS:265            COSTS(000):$0
  Waivers of Invivo Demonstration of Bioequivalence of Animal
  Drugs in Soluble Powder Oral Dosage Form and Type a Medicated
  Articles
FORMS: NONE

OMB NO: 0910-0577    EXPIRATION DATE: 01/31/2009
RESPS:300            HOURS:30             COSTS(000):$0
  Reprocessed Single-Use Device Labeling
FORMS: NONE

OMB NO: 0910-0578    EXPIRATION DATE: 03/31/2009
RESPS:36,500,000     HOURS:5,400,000      COSTS(000):$0
  Voluntary Hazard Analysis and Critical Control Point Manuals for
  Operators and Regulators of Retail and Food Service
  Establishments
FORMS: NONE

OMB NO: 0910-0579    EXPIRATION DATE: 03/31/2009
RESPS:144            HOURS:144            COSTS(000):$0
  Research Study Complaint Form
FORMS: NONE

OMB NO: 0910-0580    EXPIRATION DATE: 03/31/2009
RESPS:1,007          HOURS:1,194          COSTS(000):$0
  The Mammography Quality Standards Act Final Regulations:
  Modifications and Aditions to Policy Guidance Help System #9
FORMS: NONE

OMB NO: 0910-0581    EXPIRATION DATE: 03/31/2009
RESPS:1,148          HOURS:1,795          COSTS(000):$0
  Guidance for Industry: Clinical Trial Sponsors on the
  Establishment and Operation of Clinical Trial Data Monitoring
  Committees
FORMS: NONE

OMB NO: 0910-0582    EXPIRATION DATE: 09/30/2006
RESPS:600            HOURS:2,400          COSTS(000):$0
  Guidance on Informed Consent for in Vitro Diagnostic Studies
  Using Leftover Human Specimens that are not Individually
  Identifiable
FORMS: NONE

OMB NO: 0910-0583    EXPIRATION DATE: 04/30/2009
RESPS:20             HOURS:400            COSTS(000):$0
  Recommendations for Early Food Safety Evaluation of New
  Non-Pesticidal Proteins Produced by New Plan Varieties Intended
  for Food Use
FORMS: NONE

OMB NO: 0910-0584    EXPIRATION DATE: 12/31/2006
RESPS:20             HOURS:200            COSTS(000):$0
  Emergency Request: Guidance for Reagents for Detection of
  Specific Novel Influenza A Viruses
FORMS: NONE

OMB NO: 0910-0586    EXPIRATION DATE: 11/30/2006
RESPS:450            HOURS:900            COSTS(000):$0
  Medical Devices; Exception from General Requirements for
  Informed Consent
FORMS: NONE

OMB NO: 0910-0588    EXPIRATION DATE: 05/31/2009
RESPS:300            HOURS:100            COSTS(000):$0
  Survey of Healthcare Practitioners Regarding Their Preferences
  for Public Health Notifications
FORMS: NONE

OMB NO: 0910-0591    EXPIRATION DATE: 05/31/2009
RESPS:1              HOURS:156            COSTS(000):$0
  Evaluation of Consumer-Friendly Formats for Brief Summary in
  Direct-to-Consumer (DTC) Print Advertisements for Prescription
  Drugs: Study 1
FORMS: NONE

OMB NO: 0910-0593    EXPIRATION DATE: 12/31/2006
RESPS:96             HOURS:48             COSTS(000):$0
  MedWatch - The FDA Safety Information and Adverse Event
  Reporting Program; Proposal to Survey MedWatch Partners
  Organizations - Survey
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
167 278,535,518 152,778,424 $257,001
Health Services Administration
OMB NO: 0915-0034    EXPIRATION DATE: 08/31/2006
RESPS:16,400         HOURS:1,652          COSTS(000):$0
  Health Education Assistance Loan (HEAL) Program: Forms
FORMS: HRSA-504

OMB NO: 0915-0036    EXPIRATION DATE: 09/30/2008
RESPS:20,960         HOURS:3,767          COSTS(000):$7
  Health Education Assistance Loan (HEAL) Program: Lender's
  Application for Insurance Claim Form and Request for Collection
  Assistance Form
FORMS: NONE

OMB NO: 0915-0043    EXPIRATION DATE: 12/31/2006
RESPS:10,070         HOURS:5,055          COSTS(000):$0
  Health Education Assistance Loan (HEAL)
FORMS: HRSA-502-1

OMB NO: 0915-0044    EXPIRATION DATE: 03/31/2009
RESPS:3,977          HOURS:4,408          COSTS(000):$0
  Health Professions Student Loan and Nursing Student Loan
  Programs - Forms
FORMS: HRSA-501 HRSA-519

OMB NO: 0915-0047    EXPIRATION DATE: 10/31/2008
RESPS:133,075        HOURS:52,690         COSTS(000):$0
  Health Professions Student Loan (HPSL) Program and Nursing
  Student Loan (NSL) Program: Administrative Requirements (Regs. &
  Policy)
FORMS: NONE

OMB NO: 0915-0060    EXPIRATION DATE: 08/31/2006
RESPS:1,805          HOURS:101,531        COSTS(000):$27
  HRSA Competing Training Grant Application
FORMS: PHS-6025-1

OMB NO: 0915-0061    EXPIRATION DATE: 01/31/2008
RESPS:1,550          HOURS:33,325         COSTS(000):$0
  The Uniform Progress Reports (UPR) for HRSA Continuation
  Training Grants
FORMS: NONE

OMB NO: 0915-0077    EXPIRATION DATE: 04/30/2009
RESPS:29,208         HOURS:33,040         COSTS(000):$0
  Uncompensated Services Assurance Report
FORMS: HRSA-710

OMB NO: 0915-0099    EXPIRATION DATE: 11/30/2006
RESPS:10             HOURS:12             COSTS(000):$0
  Grants for Hospital Construction and Modernization - Federal
  Right of Recovery and Waiver of Recovery
FORMS: NONE

OMB NO: 0915-0108    EXPIRATION DATE: 01/31/2007
RESPS:280,793        HOURS:74,918         COSTS(000):$0
  Health Education Assistance Loan (HEAL) Program Regs.
FORMS: NONE

OMB NO: 0915-0126    EXPIRATION DATE: 05/31/2007
RESPS:3,319,694      HOURS:293,589        COSTS(000):$13,508
  National Practitioner Data Bank for Adverse Information on
  Physicians and Other Health Care Practitioners: Regulations and
  Forms
FORMS: NONE

OMB NO: 0915-0127    EXPIRATION DATE: 08/31/2007
RESPS:1,500          HOURS:2,163          COSTS(000):$0
  The National Health Service Corps (NHSC) Loan Repayment Program
FORMS: HRSA-873

OMB NO: 0915-0140    EXPIRATION DATE: 11/30/2007
RESPS:9,200          HOURS:54,000         COSTS(000):$0
  The Nursing Education Loan Repayment Program
FORMS: NONE

OMB NO: 0915-0142    EXPIRATION DATE: 10/31/2008
RESPS:140            HOURS:5,500          COSTS(000):$0
  Application for Certification as a Federally Qualified Health
  Center Look-Alike
FORMS: NONE

OMB NO: 0915-0146    EXPIRATION DATE: 11/30/2006
RESPS:3,100          HOURS:3,100          COSTS(000):$8
  Application for Participation in the National Health Service
  Corps Scholarship Program
FORMS: HRSA-856

OMB NO: 0915-0149    EXPIRATION DATE: 12/31/2006
RESPS:450            HOURS:10,575         COSTS(000):$0
  Scholarships for Disadvantaged Students (SDS) Graduate Survey
FORMS: NONE

OMB NO: 0915-0150    EXPIRATION DATE: 09/30/2006
RESPS:94             HOURS:94             COSTS(000):$0
  Faculty Loan Repayment Program Application
FORMS: HRSA-535

OMB NO: 0915-0151    EXPIRATION DATE: 06/30/2008
RESPS:125            HOURS:2,500          COSTS(000):$0
  Ryan White CARE Act Dental Reimbursement Program
FORMS: NONE

OMB NO: 0915-0157    EXPIRATION DATE: 08/31/2007
RESPS:559,762        HOURS:84,057         COSTS(000):$0
  Organ Procurement and Transplantation Network and Scientific
  Registry of Transplant Recipients Data System
FORMS: NONE

OMB NO: 0915-0172    EXPIRATION DATE: 05/31/2009
RESPS:59             HOURS:18,064         COSTS(000):$0
  Maternal and Child Health Services Block Grant Report
FORMS: NONE

OMB NO: 0915-0174    EXPIRATION DATE: 08/31/2006
RESPS:125            HOURS:125            COSTS(000):$0
  Loan Information System Records for the DHHS DHUD Hospital
  Mortgage Insurance, Guarantee, and Direct Loan Program
FORMS: HRSA-906

OMB NO: 0915-0176    EXPIRATION DATE: 11/30/2006
RESPS:8              HOURS:134            COSTS(000):$0
  Drug Pricing Program Reporting Requirements
FORMS: NONE

OMB NO: 0915-0179    EXPIRATION DATE: 06/30/2007
RESPS:700            HOURS:700            COSTS(000):$0
  Deferment Request Form for the National Health Service Corps
  Scholarship Program
FORMS: NONE

OMB NO: 0915-0184    EXPIRATION DATE: 12/31/2007
RESPS:36,457         HOURS:19,459         COSTS(000):$0
  Organ Procurement and Transplantation Network
FORMS: NONE

OMB NO: 0915-0193    EXPIRATION DATE: 05/31/2007
RESPS:1,045          HOURS:27,090         COSTS(000):$14,000
  Uniform Data System
FORMS: NONE

OMB NO: 0915-0204    EXPIRATION DATE: 05/31/2007
RESPS:282            HOURS:71             COSTS(000):$2
  HEAL Program: Physician's Certification of Borrower's Total and
  Permanent Disability
FORMS: 539

OMB NO: 0915-0208    EXPIRATION DATE: 12/31/2006
RESPS:308            HOURS:26             COSTS(000):$0
  Professional Training and Information Questionnaire
FORMS: HRSA-551 HRSA-552

OMB NO: 0915-0212    EXPIRATION DATE: 04/30/2009
RESPS:52,050         HOURS:5,075          COSTS(000):$0
  Voluntary Partner Surveys to Implement Executive Order 12862 in
  the Health Resources and Services Administration
FORMS: NONE

OMB NO: 0915-0230    EXPIRATION DATE: 08/31/2008
RESPS:2,900          HOURS:1,450          COSTS(000):$0
  NHSC Recruitment and Retention Assistance Application
FORMS: NONE

OMB NO: 0915-0232    EXPIRATION DATE: 10/31/2008
RESPS:900            HOURS:32,400         COSTS(000):$83
  National Health Service Corps - Uniform Data System
FORMS: NONE

OMB NO: 0915-0233    EXPIRATION DATE: 09/30/2008
RESPS:150            HOURS:825            COSTS(000):$0
  Disadvantaged Assistance Tracking and Outcome Report (DATOR) for
  Health Careers Opportunity Program and Centers of Excellence
  Program
FORMS: NONE

OMB NO: 0915-0239    EXPIRATION DATE: 08/31/2007
RESPS:946,515        HOURS:116,146        COSTS(000):$4,074
  Health Integrity and Protection Data Bank for Final Adverse
  Information on Health Care Providers, Suppliers and Practitioners
FORMS: NONE

OMB NO: 0915-0247    EXPIRATION DATE: 01/31/2007
RESPS:60             HOURS:3,840          COSTS(000):$0
  Children's Hospital Graduate Medical Eduction Program
FORMS: NONE

OMB NO: 0915-0250    EXPIRATION DATE: 06/30/2007
RESPS:1,350          HOURS:276            COSTS(000):$0
  The National Health Service Corps Scholarship Program In-School
  Worksheets
FORMS: NONE

OMB NO: 0915-0253    EXPIRATION DATE: 12/31/2007
RESPS:3,367          HOURS:107,636        COSTS(000):$0
  Ryan White Comprehensive Aids Resources Emergency Act of 1990,
  CARE Act Data Report (CADR) System
FORMS: NONE

OMB NO: 0915-0262    EXPIRATION DATE: 12/31/2006
RESPS:212            HOURS:3,816          COSTS(000):$0
  Office of State and National Partnership's Web-based Semi Annual
  Report
FORMS: NONE

OMB NO: 0915-0268    EXPIRATION DATE: 02/28/2009
RESPS:86             HOURS:688            COSTS(000):$0
  Implementation of the Primary Care Surveillance System (PSCC)
  Core Data Collection Effort for the Sentinal Centers Network
  (SCN)
FORMS: NONE

OMB NO: 0915-0275    EXPIRATION DATE: 12/31/2007
RESPS:16,800         HOURS:25,200         COSTS(000):$0
  Ryan White Comprehensive Aids Resources Emergency Act of 1990,
  Title III and IV Client-Level Data Project (CDP) Reporting System
FORMS: NONE

OMB NO: 0915-0278    EXPIRATION DATE: 10/31/2006
RESPS:622            HOURS:41             COSTS(000):$0
  NHSC Travel Request Worksheet
FORMS: NONE

OMB NO: 0915-0281    EXPIRATION DATE: 12/31/2006
RESPS:13,536         HOURS:32,502         COSTS(000):$0
  AIDS Education and Training Centers
FORMS: NONE

OMB NO: 0915-0282    EXPIRATION DATE: 08/31/2007
RESPS:2,500          HOURS:7,500          COSTS(000):$0
  Smallpox Vaccine Injury Compensation Program
FORMS: NONE

OMB NO: 0915-0285    EXPIRATION DATE: 06/30/2007
RESPS:1,425          HOURS:59,375         COSTS(000):$0
  The Presidential Initiative Applications for Funding
  Opportunities
FORMS: NONE

OMB NO: 0915-0286    EXPIRATION DATE: 06/30/2007
RESPS:4              HOURS:18             COSTS(000):$0
  Organ Procurement and Transplantation Network (42 CFR Part
  121.3(b)(4) and 121.9(d))
FORMS: NONE

OMB NO: 0915-0289    EXPIRATION DATE: 09/30/2007
RESPS:314            HOURS:14,130         COSTS(000):$0
  Health Care Infrastructure Application Forms for Funding
  Opportunities
FORMS: NONE

OMB NO: 0915-0292    EXPIRATION DATE: 09/30/2007
RESPS:15             HOURS:150            COSTS(000):$0
  Black Lung Clinics Program Database
FORMS: NONE

OMB NO: 0915-0293    EXPIRATION DATE: 08/31/2008
RESPS:150            HOURS:2,400          COSTS(000):$0
  Free Clinics FTCA Program Application
FORMS: NONE

OMB NO: 0915-0294    EXPIRATION DATE: 01/31/2008
RESPS:228            HOURS:428            COSTS(000):$0
  HRSA AIDS Drug Assistance Quarterly Report
FORMS: NONE

OMB NO: 0915-0295    EXPIRATION DATE: 02/29/2008
RESPS:4,900          HOURS:2,750          COSTS(000):$0
  Grant Reviewer Recruitment Form
FORMS: NONE

OMB NO: 0915-0297    EXPIRATION DATE: 09/30/2006
RESPS:126            HOURS:108            COSTS(000):$0
  Survey of Universal Newborn Hearing Screening and Intervention
  Programs
FORMS: NONE

OMB NO: 0915-0298    EXPIRATION DATE: 03/31/2009
RESPS:631            HOURS:3,786          COSTS(000):$0
  Maternal and Child Health Bureau Performance Measures for
  Discretionary Grants
FORMS: NONE

OMB NO: 0915-0300    EXPIRATION DATE: 06/30/2007
RESPS:633            HOURS:316            COSTS(000):$0
  Healthy Start Participant Survey
FORMS: NONE

OMB NO: 0915-0301    EXPIRATION DATE: 07/31/2009
RESPS:5,000          HOURS:4,750          COSTS(000):$0
  The Nursing Scholarship Program
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
52 5,485,371 1,257,251 $31,709
Indian Health Service
OMB NO: 0917-0002    EXPIRATION DATE: 11/30/2006
RESPS:338,403        HOURS:16,920         COSTS(000):$0
  IHS Contract Health Service Purchase-Delivery Order for Health
  Service
FORMS: IHS843-1A

OMB NO: 0917-0006    EXPIRATION DATE: 09/30/2007
RESPS:17,330         HOURS:5,536          COSTS(000):$0
  IHS Scholarship Program Application
FORMS: 856 856-2 856-3 856-4 856-5 856-6

OMB NO: 0917-0007    EXPIRATION DATE: 09/30/2007
RESPS:34             HOURS:514            COSTS(000):$0
  IHS Urban Indian Health Program Common Reporting Requirements
FORMS: NONE

OMB NO: 0917-0009    EXPIRATION DATE: 08/31/2006
RESPS:3,709          HOURS:2,371          COSTS(000):$0
  Indian Health Service Medical Staff Credentials and Privileges
  Files
FORMS: NONE

OMB NO: 0917-0014    EXPIRATION DATE: 12/31/2008
RESPS:2,125          HOURS:1,382          COSTS(000):$0
  Indian Health Service Loan Repayment Program
FORMS: NONE

OMB NO: 0917-0025    EXPIRATION DATE: 05/31/2007
RESPS:1              HOURS:384            COSTS(000):$0
  Hoz'ho'nii: An Intervention to Increase Breat and Cervical
  Cancer Screening Among Navajo Women
FORMS: NONE

OMB NO: 0917-0026    EXPIRATION DATE: 12/31/2008
RESPS:50             HOURS:3,720          COSTS(000):$0
  Final Rule to Implement Title V of the Tribal Self-Governance
  Amendments of 2000
FORMS: NONE

OMB NO: 0917-0028    EXPIRATION DATE: 02/28/2009
RESPS:2,000          HOURS:500            COSTS(000):$0
  IHS Background Investigations of Individuals in Positions
  Involving Regular Contact with or Control Over Indian Children
FORMS: 306

OMB NO: 0917-0030    EXPIRATION DATE: 08/31/2006
RESPS:542,500        HOURS:174,375        COSTS(000):$0
  IHS Forms To Implement The Privacy Rule (45 CFR Parts 160 and
  164)
FORMS: NONE

OMB NO: 0917-0031    EXPIRATION DATE: 07/31/2007
RESPS:108            HOURS:18             COSTS(000):$0
  Chief Executive Officer Retention Survey
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
10 906,260 205,720 $0
Centers for Disease Control and Prevention
OMB NO: 0920-0004    EXPIRATION DATE: 10/31/2006
RESPS:1,277          HOURS:12,732         COSTS(000):$0
  National Disease Surveillance Program - II. Disease Summaries
FORMS: CDC-52.12 52.13 52.19 52.20 52.28 55.41 55.9 55.20 55.31
55.31A/55.83A-C

OMB NO: 0920-0006    EXPIRATION DATE: 02/28/2009
RESPS:600            HOURS:167            COSTS(000):$16
  Application for Waiver of Inadmissibility Under Immigration and
  Nationality Act
FORMS: CDC-4.422-1 CDC-4.422-1A CDC-4.422-1B

OMB NO: 0920-0007    EXPIRATION DATE: 07/31/2007
RESPS:12,329         HOURS:5,455          COSTS(000):$0
  Weekly and Annual Morbidity and Mortality Reports
FORMS: CDC43.5A

OMB NO: 0920-0008    EXPIRATION DATE: 09/30/2006
RESPS:15,000         HOURS:3,750          COSTS(000):$0
  Emergency Epidemic Investigations
FORMS: NONE

OMB NO: 0920-0009    EXPIRATION DATE: 11/30/2006
RESPS:51,564         HOURS:14,508         COSTS(000):$0
  National Disease Surveillance Program - 1. Case Reports
FORMS: CDC-53.1 CDC-52.15 CDC-56.31A CDC-56.31B CDC-55.54 CDC-52-56
CDC-52.18 CDC-52.60 CDC-54.1 CDC-56.37

OMB NO: 0920-0010    EXPIRATION DATE: 05/31/2009
RESPS:400            HOURS:600            COSTS(000):$0
  National Birth Defects Prevention Study (formerly titled: Metro
  Atlanta Birth Defects & Factor Surveillance Program)
FORMS: NONE

OMB NO: 0920-0012    EXPIRATION DATE: 02/29/2008
RESPS:83,890         HOURS:66,775         COSTS(000):$47,520
  National Nosocomial Infections Surveillance System (NNIS)
FORMS: NONE

OMB NO: 0920-0017    EXPIRATION DATE: 12/31/2006
RESPS:45,525         HOURS:3,582          COSTS(000):$0
  Application for Training
FORMS: CDC-FORM-32.1 CDC-FORM-36.5

OMB NO: 0920-0020    EXPIRATION DATE: 09/30/2007
RESPS:8,025          HOURS:1,246          COSTS(000):$0
  National Coal Workers' X-ray Surveillance Program (CWXSP) -
  Federal Mine Safety and Health Act 1977 (42CFR37)
FORMS: NIOSH(M)-2.8 NIOSH(M)-2.9 NIOSH(M)-2.10 NIOSH(M)-2.11
NIOSH(M)-2.12

OMB NO: 0920-0021    EXPIRATION DATE: 11/30/2006
RESPS:50             HOURS:21             COSTS(000):$0
  National Coal Workers' Autopsy Study (42 cfr 37.204)
FORMS: CDC/NIOSH-2.6

OMB NO: 0920-0026    EXPIRATION DATE: 11/30/2008
RESPS:15,120         HOURS:7,560          COSTS(000):$0
  National Tuberculosis Surveillance
FORMS: CDC-72.9A CDC-72.9B CDC-72.9C

OMB NO: 0920-0106    EXPIRATION DATE: 10/31/2008
RESPS:122            HOURS:4,270          COSTS(000):$0
  Preventive Health and Health Services Block Grant
FORMS: NONE

OMB NO: 0920-0109    EXPIRATION DATE: 11/30/2007
RESPS:430            HOURS:98,470         COSTS(000):$0
  Information Collection Provisions in 42 CFR Part 84 - Tests and
  Requirements for Certification and Approval of Respiratory
  Protective Devices
FORMS: NONE

OMB NO: 0920-0128    EXPIRATION DATE: 09/30/2006
RESPS:500            HOURS:130            COSTS(000):$0
  Congenital Syphilis Case Investigation and Report Form
FORMS: CDC-73.126

OMB NO: 0920-0134    EXPIRATION DATE: 12/31/2008
RESPS:2,711,601      HOURS:225,759        COSTS(000):$0
  Foreign Quarantine Regulations
FORMS: NONE

OMB NO: 0920-0138    EXPIRATION DATE: 02/29/2008
RESPS:67             HOURS:52             COSTS(000):$0
  Pulmonary Function Testing Course Approval Program
FORMS: NONE

OMB NO: 0920-0199    EXPIRATION DATE: 08/31/2006
RESPS:4,452          HOURS:1,206          COSTS(000):$0
  Importation and Transportation of Etiologic Agents (42 CFR 71.54
  and Part 72)
FORMS: 0.753

OMB NO: 0920-0210    EXPIRATION DATE: 08/31/2007
RESPS:143            HOURS:930            COSTS(000):$0
  List of Ingredients Added in the Manufacture of Cigarette
  Products
FORMS: NONE

OMB NO: 0920-0212    EXPIRATION DATE: 08/31/2008
RESPS:47,525         HOURS:2,131          COSTS(000):$0
  National Hospital Discharge Survey
FORMS: NONE

OMB NO: 0920-0213    EXPIRATION DATE: 02/28/2009
RESPS:1,150          HOURS:208            COSTS(000):$0
  National Vital Statistics Report Forms
FORMS: CDC-64.147 CDC-64.146

OMB NO: 0920-0214    EXPIRATION DATE: 12/31/2007
RESPS:43,417         HOURS:36,821         COSTS(000):$0
  National Health Interview Survey: Basic Module with 2005 Topical
  Modules
FORMS: NONE

OMB NO: 0920-0215    EXPIRATION DATE: 11/30/2007
RESPS:780            HOURS:227            COSTS(000):$0
  Application form and related forms for the operation of the
  National Death Index
FORMS: CDC/NCHS-6205-1 CDC-64.24 CDC-64.25 PHS-6205-3 CDC/NCHS-6205-6

OMB NO: 0920-0217    EXPIRATION DATE: 07/31/2007
RESPS:157            HOURS:44             COSTS(000):$0
  NCHS Application for Vital Statistics Training Form
FORMS: CDC-64.52

OMB NO: 0920-0222    EXPIRATION DATE: 01/31/2007
RESPS:460            HOURS:600            COSTS(000):$0
  NCHS Questionnaire Design Research Laboratory
FORMS: NONE

OMB NO: 0920-0234    EXPIRATION DATE: 05/31/2007
RESPS:85,360         HOURS:7,460          COSTS(000):$0
  NCHS National Ambulatory Medical Care Survey, 2005-2006
FORMS: CDC-64.148 CDC-64.149

OMB NO: 0920-0237    EXPIRATION DATE: 03/31/2007
RESPS:22,913         HOURS:63,092         COSTS(000):$0
  NCHS National Health and Nutrition Examination Survey (NHANES)
  2005-2006
FORMS: NONE

OMB NO: 0920-0255    EXPIRATION DATE: 08/31/2006
RESPS:19,133         HOURS:3,858          COSTS(000):$0
  Resources and Services Database for the CDC National Prevention
  Information Network
FORMS: NONE

OMB NO: 0920-0260    EXPIRATION DATE: 11/30/2007
RESPS:11,840         HOURS:3,991          COSTS(000):$0
  Health Hazard Evaluations/Technical Assistance and Emerging
  Problems
FORMS: NONE

OMB NO: 0920-0261    EXPIRATION DATE: 04/30/2007
RESPS:77             HOURS:10,631         COSTS(000):$0
  NIOSH Training Grants Applications (42 CFR 86)
FORMS: CDC-2.145A CDC-2.145B

OMB NO: 0920-0263    EXPIRATION DATE: 05/31/2008
RESPS:100            HOURS:20             COSTS(000):$0
  Requirements for a Special Permit to Import Cynomolgus, African
  Green, or Rhesus Monkeys into the United States
FORMS: CDC-75.10A

OMB NO: 0920-0274    EXPIRATION DATE: 10/31/2007
RESPS:4,245          HOURS:1,057          COSTS(000):$0
  CDC Model Performance Evaluation Program (MPEP) for Retroviral
  and AIDS-Related Testing
FORMS: NONE

OMB NO: 0920-0278    EXPIRATION DATE: 05/31/2007
RESPS:94,970         HOURS:10,030         COSTS(000):$0
  NCHS National Hospital Ambulatory Medical Care Survey, 2005-2006
FORMS: 101(CDC-64.151) 101U(CDC-64.150 CDC-64.136 CDC-64.135

OMB NO: 0920-0282    EXPIRATION DATE: 04/30/2007
RESPS:168            HOURS:336            COSTS(000):$0
  The Childhood Lead Poisoning Prevention Program Quarterly Report
FORMS: NONE

OMB NO: 0920-0295    EXPIRATION DATE: 09/30/2006
RESPS:48,100         HOURS:1,342          COSTS(000):$0
  National AIDS and STD Hotline Survey of Callers
FORMS: NONE

OMB NO: 0920-0298    EXPIRATION DATE: 07/31/2009
RESPS:12,320         HOURS:6,088          COSTS(000):$0
  National Home and Hospice Care Survey
FORMS: NONE

OMB NO: 0920-0307    EXPIRATION DATE: 01/31/2008
RESPS:1,644          HOURS:8,142          COSTS(000):$0
  Gonococcal Isolate Surveillance Project
FORMS: CDC-73.60A 73.60B 73.60C

OMB NO: 0920-0314    EXPIRATION DATE: 04/30/2009
RESPS:14,970         HOURS:6,457          COSTS(000):$0
  National Survey of Family Growth, Cycle 7
FORMS: NONE

OMB NO: 0920-0334    EXPIRATION DATE: 11/30/2008
RESPS:70,272         HOURS:11,231         COSTS(000):$0
  National Survey of Ambulatory Surgery
FORMS: NONE

OMB NO: 0920-0337    EXPIRATION DATE: 05/31/2008
RESPS:336            HOURS:672            COSTS(000):$0
  National Blood Lead Surveillance System
FORMS: NONE

OMB NO: 0920-0338    EXPIRATION DATE: 08/31/2007
RESPS:11             HOURS:18,838         COSTS(000):$0
  List of Ingredients Added in the Manufacture of Smokeless
  Tobacco Products
FORMS: NONE

OMB NO: 0920-0353    EXPIRATION DATE: 05/31/2007
RESPS:29,250         HOURS:13,375         COSTS(000):$0
  National Nursing Home Survey
FORMS: NONE

OMB NO: 0920-0406    EXPIRATION DATE: 11/30/2007
RESPS:620,325        HOURS:55,190         COSTS(000):$0
  State and Local Area Integrated Telephone Survey (SLAITS)
FORMS: NONE

OMB NO: 0920-0417    EXPIRATION DATE: 02/29/2008
RESPS:1,349          HOURS:17,907         COSTS(000):$15
  National Surveillance System for Health Care Workers
FORMS: NONE

OMB NO: 0920-0428    EXPIRATION DATE: 08/31/2006
RESPS:21,379         HOURS:49,049         COSTS(000):$0
  PHS Supplements to Application for Federal Assistance (SF 424)
FORMS: SF-424 PHS-5161-1 CDC.124(E) CDC.0113 OPHS-1

OMB NO: 0920-0442    EXPIRATION DATE: 08/31/2006
RESPS:223            HOURS:6,300          COSTS(000):$0
  Surveillance for Bloodstream and Vascular Access Infections in
  Outpatient Hemodialysis Centers
FORMS: NONE

OMB NO: 0920-0445    EXPIRATION DATE: 11/30/2008
RESPS:19.086         HOURS:22,812         COSTS(000):$0
  School Health Policies and Programs Study 2006 (SHPPS 2006)
FORMS: NONE

OMB NO: 0920-0457    EXPIRATION DATE: 08/31/2006
RESPS:68             HOURS:340            COSTS(000):$0
  Aggregate Reports for Tuberculosis Program Evaluation
FORMS: NONE

OMB NO: 0920-0463    EXPIRATION DATE: 04/30/2009
RESPS:100            HOURS:50             COSTS(000):$0
  Longitudinal Surveillance for Beryllium Disease Prevention
FORMS: NONE

OMB NO: 0920-0469    EXPIRATION DATE: 11/30/2006
RESPS:63             HOURS:126            COSTS(000):$0
  National Program of Cancer Registries Cancer Surveillance System
FORMS: NONE

OMB NO: 0920-0472    EXPIRATION DATE: 09/30/2006
RESPS:16,749         HOURS:2,689          COSTS(000):$0
  Assessment of Exposure to Aresenic Through Household Water
FORMS: NONE

OMB NO: 0920-0479    EXPIRATION DATE: 08/31/2006
RESPS:59             HOURS:236            COSTS(000):$1
  Automated Management Information System (MIS) for Diabetes
  Control Programs
FORMS: NONE

OMB NO: 0920-0487    EXPIRATION DATE: 09/30/2006
RESPS:745            HOURS:173            COSTS(000):$0
  Risk Factors for Microbial Contamination of Produce: A Field
  Study of Domestic and Imported Produce in Packing Sheds
FORMS: NONE

OMB NO: 0920-0488    EXPIRATION DATE: 12/31/2006
RESPS:16,500         HOURS:3,600          COSTS(000):$0
  Restrictions on Interstate Travel of Persons
FORMS: NONE

OMB NO: 0920-0489    EXPIRATION DATE: 04/30/2008
RESPS:3,960          HOURS:3,960          COSTS(000):$0
  US-MX Border Diabetes Prevention and Control Project - Phase 2
  Community Intervention Pilot Study
FORMS: NONE

OMB NO: 0920-0493    EXPIRATION DATE: 11/30/2007
RESPS:8,230          HOURS:6,115          COSTS(000):$0
  2005 and 2007 Youth Risk Behavior Surveys
FORMS: NONE

OMB NO: 0920-0494    EXPIRATION DATE: 12/31/2008
RESPS:605            HOURS:128            COSTS(000):$0
  Exposure to Aerosolized Brevetoxins During Red Tide Events
FORMS: NONE

OMB NO: 0920-0499    EXPIRATION DATE: 08/31/2007
RESPS:80             HOURS:800            COSTS(000):$0
  Jail STD Prevalence Monitoring System
FORMS: NONE

OMB NO: 0920-0502    EXPIRATION DATE: 06/30/2007
RESPS:29,647         HOURS:8,138          COSTS(000):$0
  REACH 2010 Evaluation
FORMS: NONE

OMB NO: 0920-0527    EXPIRATION DATE: 02/28/2007
RESPS:638            HOURS:231            COSTS(000):$0
  Human Exposure to Cynobacterial (Blue-green Algal) Toxins in
  Drinking Water: Risk of Exposure to Microcystins from Public
  Water Systems
FORMS: NONE

OMB NO: 0920-0530    EXPIRATION DATE: 01/31/2009
RESPS:12,600         HOURS:4,900          COSTS(000):$0
  EEOICPA Dose Reconstruction Interviews and Form
FORMS: OCAS-1

OMB NO: 0920-0555    EXPIRATION DATE: 12/31/2008
RESPS:175            HOURS:4,200          COSTS(000):$0
  National Public Health Performance Standards Program Local
  Public Health Performance Assessment
FORMS: NONE

OMB NO: 0920-0556    EXPIRATION DATE: 08/31/2006
RESPS:400            HOURS:63,400         COSTS(000):$0
  Assisted Reproductive Technology (ART) Program Reporting System
FORMS: NONE

OMB NO: 0920-0557    EXPIRATION DATE: 12/31/2008
RESPS:7              HOURS:105            COSTS(000):$0
  National Public Health Performance Standards Program State
  Public Health Performance Assessment
FORMS: NONE

OMB NO: 0920-0571    EXPIRATION DATE: 11/30/2006
RESPS:273            HOURS:2,343          COSTS(000):$0
  Minimum Data Elements/System for Technical Assistance Reporting
  for the National Breast and Cervical Cancer Early Detection
  Program
FORMS: NONE

OMB NO: 0920-0572    EXPIRATION DATE: 06/30/2008
RESPS:6,400          HOURS:2,500          COSTS(000):$0
  CDC and ATSDR Health Massage Testing System
FORMS: NONE

OMB NO: 0920-0573    EXPIRATION DATE: 11/30/2006
RESPS:79,981         HOURS:13,191         COSTS(000):$0
  Adult and Pediatric Confidential HIV/AIDS Case Report
FORMS: CDC-50.42A CDC-50.42B

OMB NO: 0920-0576    EXPIRATION DATE: 03/31/2009
RESPS:5,324          HOURS:7,785          COSTS(000):$0
  Possession, Use, and Transfer of Select Agents and Toxins (42
  CFR 73)
FORMS: 0.1316 0.1317 0.1318 0.1319 EA-101

OMB NO: 0920-0580    EXPIRATION DATE: 12/31/2006
RESPS:1,067          HOURS:6,402          COSTS(000):$0
  National Public Health Performance Standards Program Local
  Public Health Governance Performance Assessment Tool
FORMS: NONE

OMB NO: 0920-0582    EXPIRATION DATE: 05/31/2007
RESPS:33,127         HOURS:2,362          COSTS(000):$0
  YMC Tracking Study
FORMS: NONE

OMB NO: 0920-0587    EXPIRATION DATE: 11/30/2006
RESPS:29,490         HOURS:4,887          COSTS(000):$0
  Outcome Follow-up Survey of CDC's Youth Media Campaign
FORMS: NONE

OMB NO: 0920-0591    EXPIRATION DATE: 09/30/2007
RESPS:900            HOURS:450            COSTS(000):$0
  Select Agent Distribution Activity; Request for Select Agent
FORMS: NONE

OMB NO: 0920-0595    EXPIRATION DATE: 12/31/2006
RESPS:900            HOURS:175            COSTS(000):$0
  HIV Rapid Testing Performance Evaluation Sample and Laboratory
  Practices Questionnaire Surveys
FORMS: NONE

OMB NO: 0920-0596    EXPIRATION DATE: 09/30/2007
RESPS:5,700          HOURS:1,583          COSTS(000):$0
  Severe Acute Respiratory Syndrome (SARS) Investigation
FORMS: NONE

OMB NO: 0920-0599    EXPIRATION DATE: 09/30/2007
RESPS:1,070          HOURS:555            COSTS(000):$0
  A Community-Based Intervention Model to Promote Neighborhood
  Participation in the Reduction of Aedes aegypti indices in
  Puerto Rico
FORMS: CDC-50.133

OMB NO: 0920-0600    EXPIRATION DATE: 09/30/2006
RESPS:330            HOURS:165            COSTS(000):$0
  Centers for Disease Control and Prevention Performance
  Evaluation Program for Mycobacterium
  Tuberculosis/Non-tuberculosis Mycobacteria Drug Susceptibility
  Testing Program
FORMS: NONE

OMB NO: 0920-0601    EXPIRATION DATE: 08/31/2006
RESPS:102            HOURS:612            COSTS(000):$0
  National Tobacco Control Program Chronicle Progress Reporting
  System
FORMS: NONE

OMB NO: 0920-0602    EXPIRATION DATE: 10/31/2006
RESPS:90,048         HOURS:28,860         COSTS(000):$0
  Work and Health Study: Risk Factors for Heart Disease and
  Depression in the Workplace
FORMS: NONE

OMB NO: 0920-0603    EXPIRATION DATE: 09/30/2006
RESPS:84             HOURS:84             COSTS(000):$0
  Racial and Ethnic Approaches to Community Health 2010
  Information Network (REACH IN)
FORMS: NONE

OMB NO: 0920-0604    EXPIRATION DATE: 11/30/2006
RESPS:70             HOURS:70             COSTS(000):$0
  School-Associated Violent Deaths Surveillance System
FORMS: NONE

OMB NO: 0920-0607    EXPIRATION DATE: 11/30/2006
RESPS:20,000         HOURS:25,000         COSTS(000):$0
  The National Violent Death Reporting System (NVDRS)
FORMS: NONE

OMB NO: 0920-0610    EXPIRATION DATE: 12/31/2006
RESPS:650            HOURS:325            COSTS(000):$0
  Evaluation of the Process Required to Effectively Expand the
  National Laboratory System (NLS) to All States
FORMS: NONE

OMB NO: 0920-0612    EXPIRATION DATE: 11/30/2006
RESPS:150            HOURS:2,160          COSTS(000):$0
  WISEWOMAN Reporting System
FORMS: NONE

OMB NO: 0920-0614    EXPIRATION DATE: 11/30/2006
RESPS:5              HOURS:120            COSTS(000):$0
  International Performance Standards Project
FORMS: NONE

OMB NO: 0920-0621    EXPIRATION DATE: 12/31/2008
RESPS:25,037         HOURS:18,644         COSTS(000):$0
  National Youth Tobacco Survey (NYTS)
FORMS: NONE

OMB NO: 0920-0622    EXPIRATION DATE: 01/31/2007
RESPS:532            HOURS:400            COSTS(000):$0
  The Domestic Violence Prevention Enhancement and Leadership
  through Alliances (DELTA) Program
FORMS: NONE

OMB NO: 0920-0624    EXPIRATION DATE: 10/31/2008
RESPS:667            HOURS:167            COSTS(000):$0
  An Evaluation of the Use and Effectiveness of Internet SAMMEC
FORMS: NONE

OMB NO: 0920-0628    EXPIRATION DATE: 03/31/2007
RESPS:4,015          HOURS:6,030          COSTS(000):$0
  Housing and Health Study
FORMS: NONE

OMB NO: 0920-0630    EXPIRATION DATE: 04/30/2007
RESPS:2,550          HOURS:1,892          COSTS(000):$0
  Work Organization Predictors of Depression in Women
FORMS: NONE

OMB NO: 0920-0632    EXPIRATION DATE: 02/28/2007
RESPS:2,000          HOURS:400            COSTS(000):$0
  Clinicians' Management Approach to Children with Pharyngitis
FORMS: NONE

OMB NO: 0920-0636    EXPIRATION DATE: 12/31/2007
RESPS:1,000          HOURS:167            COSTS(000):$0
  State-Based Evaluation of the Alert Notification Component of
  CDC's Secure Communications Network (EPI-X)
FORMS: NONE

OMB NO: 0920-0639    EXPIRATION DATE: 05/31/2007
RESPS:90             HOURS:54             COSTS(000):$0
  EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)
FORMS: NONE

OMB NO: 0920-0641    EXPIRATION DATE: 09/30/2006
RESPS:217            HOURS:36             COSTS(000):$0
  Descriptive Epidemiology of Missed or Delayed Diagnosis for
  Conditions Detected by Newborn Screening
FORMS: NONE

OMB NO: 0920-0643    EXPIRATION DATE: 06/30/2007
RESPS:221,600        HOURS:17,026         COSTS(000):$0
  Assessment Information About the National Center for Injury
  Prevention and Control (NCIPC) Publications
FORMS: NONE

OMB NO: 0920-0646    EXPIRATION DATE: 08/31/2007
RESPS:31,325         HOURS:2,365          COSTS(000):$0
  Cross-sectional Survey for the Evaluation of the CDC Youth Media
  Campaign
FORMS: NONE

OMB NO: 0920-0648    EXPIRATION DATE: 07/31/2007
RESPS:100            HOURS:58             COSTS(000):$0
  NCHS Technology and Aging Pilot Survey
FORMS: NONE

OMB NO: 0920-0649    EXPIRATION DATE: 09/30/2007
RESPS:29,125         HOURS:4,855          COSTS(000):$0
  Assessment of Educational Materials and Information Distribution
  Systems
FORMS: NONE

OMB NO: 0920-0650    EXPIRATION DATE: 11/30/2007
RESPS:132            HOURS:279            COSTS(000):$0
  Prevention Research Centers Information System
FORMS: NONE

OMB NO: 0920-0651    EXPIRATION DATE: 07/31/2008
RESPS:240            HOURS:210            COSTS(000):$0
  Evaluation of Educational Materials Promoting Informed Decision
  Making About Prostate Cancer Screening - PHASE II: RCT
FORMS: 35038-25

OMB NO: 0920-0655    EXPIRATION DATE: 09/30/2006
RESPS:656            HOURS:100            COSTS(000):$0
  Accommodation of Noise-Exposed, Hearing-Impaired Workers
FORMS: NONE

OMB NO: 0920-0658    EXPIRATION DATE: 11/30/2007
RESPS:3,060          HOURS:1,462          COSTS(000):$0
  CDC HIV Prevention Capacity-Building Assistance (CBA)
  Information Collection, Reporting, and Monitoring Forms
FORMS: NONE

OMB NO: 0920-0660    EXPIRATION DATE: 02/29/2008
RESPS:504            HOURS:109            COSTS(000):$0
  Surveillance Survey for the Guide to Community Preventive
  Services
FORMS: NONE

OMB NO: 0920-0662    EXPIRATION DATE: 01/31/2008
RESPS:56             HOURS:36             COSTS(000):$0
  Learning from Principal Investigators of Research Projects
  Funded through the Extramural Prevention Research Program: How
  Can CDC Best Support Participatory Research and the....
FORMS: NONE

OMB NO: 0920-0666    EXPIRATION DATE: 02/29/2008
RESPS:174,395        HOURS:65,817         COSTS(000):$39,600
  The National Healthcare Safety Network
FORMS: 57.75A-Z 57.75Z(1-3) 57.75AA-DD

OMB NO: 0920-0667    EXPIRATION DATE: 09/30/2006
RESPS:1,637          HOURS:250            COSTS(000):$0
  Active Surveillance for Ciguatera Fish Poisoning in Culebra,
  Puerto Rico
FORMS: NONE

OMB NO: 0920-0668    EXPIRATION DATE: 02/28/2007
RESPS:1,138          HOURS:570            COSTS(000):$0
  Minority HIV/AIDS Research Initiative: "Access to HIV Testing
  and Treatment in the Rural South"
FORMS: NONE

OMB NO: 0920-0669    EXPIRATION DATE: 01/31/2008
RESPS:40             HOURS:672            COSTS(000):$0
  Evaluation of "State Nutrition and Physical Activity Programs to
  Prevent Obesity and Other Chronic Diseases"
FORMS: NONE

OMB NO: 0920-0670    EXPIRATION DATE: 09/30/2006
RESPS:1,800          HOURS:300            COSTS(000):$0
  Evaluation of Efficacy of Household Water Filtration/Treatment
  Devices in Households with Private Wells
FORMS: NONE

OMB NO: 0920-0671    EXPIRATION DATE: 01/31/2008
RESPS:909            HOURS:609            COSTS(000):$0
  American Indian and Alaska Native Adult Tobacco Surveys
FORMS: NONE

OMB NO: 0920-0672    EXPIRATION DATE: 02/29/2008
RESPS:96             HOURS:718            COSTS(000):$0
  Indicators of the Performance of Local and State Education
  Agencies in HIV Prevention and Coordinated School Health Program
  Activities for Adolescent and School Health Programs
FORMS: NONE

OMB NO: 0920-0673    EXPIRATION DATE: 02/28/2007
RESPS:14,750         HOURS:1,750          COSTS(000):$0
  ACHES (Arthritis Conditions Health Effects Survey)
FORMS: NONE

OMB NO: 0920-0674    EXPIRATION DATE: 01/31/2008
RESPS:4,045          HOURS:301            COSTS(000):$0
  Evaluation of a Concussion Tool Kit - Heads Up: Concussion in
  High School Sports
FORMS: NONE

OMB NO: 0920-0675    EXPIRATION DATE: 11/30/2006
RESPS:311            HOURS:156            COSTS(000):$0
  Evaluation of the James A. Ferguson Emerging Infectious Diseases
  Fellowship Program
FORMS: NONE

OMB NO: 0920-0677    EXPIRATION DATE: 02/29/2008
RESPS:140            HOURS:47             COSTS(000):$0
  Sexually Transmitted Diseases Laboratory Test Method Survey
FORMS: NONE

OMB NO: 0920-0678    EXPIRATION DATE: 11/30/2006
RESPS:630            HOURS:158            COSTS(000):$0
  Increasing Cervical Cancer Screening in Never or Rarely Screened
  Black Women: Phase I
FORMS: NONE

OMB NO: 0920-0679    EXPIRATION DATE: 05/31/2008
RESPS:132            HOURS:396            COSTS(000):$0
  Cardiovascular Health Branch Management Information System
FORMS: NONE

OMB NO: 0920-0680    EXPIRATION DATE: 10/31/2008
RESPS:108            HOURS:18             COSTS(000):$0
  Severe Acute Respitory Syndrome (SARS) Model Performance
  Evaluation Program (MPEP)
FORMS: NONE

OMB NO: 0920-0681    EXPIRATION DATE: 02/28/2007
RESPS:115            HOURS:145            COSTS(000):$0
  Comprehensive Cancer Control: Implementation Case Studies
FORMS: NONE

OMB NO: 0920-0682    EXPIRATION DATE: 12/31/2006
RESPS:344            HOURS:460            COSTS(000):$0
  Assessment of Occupational Exposures to Electric and Magnetic
  Fields (EMF)
FORMS: NONE

OMB NO: 0920-0684    EXPIRATION DATE: 08/31/2007
RESPS:20,920         HOURS:5,922          COSTS(000):$0
  Evaluating Tools for Health Promotion and Disease Prevention
FORMS: NONE

OMB NO: 0920-0686    EXPIRATION DATE: 10/31/2006
RESPS:356            HOURS:178            COSTS(000):$0
  Ecology of Bats in Households: A Survey for Assessing Knowledge,
  Attitudes, and Health Risks
FORMS: NONE

OMB NO: 0920-0689    EXPIRATION DATE: 08/31/2008
RESPS:199            HOURS:56             COSTS(000):$0
  Factors Impacting Effective Removal of Arsenic by Household
  Water Purification Systems
FORMS: NONE

OMB NO: 0920-0691    EXPIRATION DATE: 08/31/2008
RESPS:102            HOURS:26             COSTS(000):$0
  State Medicaid Tobacco Coverage Survey
FORMS: NONE

OMB NO: 0920-0692    EXPIRATION DATE: 08/31/2008
RESPS:4,000          HOURS:2,000          COSTS(000):$0
  A Survey of the Knowledge, Attitudes, and Practice of Medical
  and Allied Health Professionals Regarding Fetal Alcohol Exposure
FORMS: NONE

OMB NO: 0920-0693    EXPIRATION DATE: 10/31/2008
RESPS:625            HOURS:646            COSTS(000):$0
  Validating Autism Surveillance Methodology in Metropolitan
  Atlanta Developmental Disabilities Surveillance Program (MADDSP)
FORMS: NONE

OMB NO: 0920-0694    EXPIRATION DATE: 11/30/2008
RESPS:150            HOURS:54             COSTS(000):$0
  Potential Reproductive and Neurological Effects of Exposure to
  Acrylamide
FORMS: NONE

OMB NO: 0920-0696    EXPIRATION DATE: 11/30/2006
RESPS:2,152          HOURS:122,172        COSTS(000):$2
  HIV Prevention Program Evaluation and Monitoring System for
  Health Departments and Community-Based Organizations (PEMS)
FORMS: NONE

OMB NO: 0920-0697    EXPIRATION DATE: 10/31/2007
RESPS:678            HOURS:285            COSTS(000):$0
  Fire Fighter Fatality Investigation and Prevention Program
  (FFFIPP)
FORMS: NONE

OMB NO: 0920-0698    EXPIRATION DATE: 11/30/2007
RESPS:50             HOURS:25             COSTS(000):$0
  How Miners Modify Their Behavior in Response To Personal Dust
  Monitor Information
FORMS: NONE

OMB NO: 0920-0699    EXPIRATION DATE: 11/30/2008
RESPS:6,900          HOURS:18,970         COSTS(000):$0
  Collection of Assessment Information about the Centers for
  Disease Control and Prevention Publications
FORMS: NONE

OMB NO: 0920-0700    EXPIRATION DATE: 11/30/2008
RESPS:56,900         HOURS:18,970         COSTS(000):$0
  Collection of Assessment Information About the Centers for
  Disease Control and Prevention (CDC) Publications
FORMS: NONE

OMB NO: 0920-0701    EXPIRATION DATE: 05/31/2007
RESPS:2,400          HOURS:450            COSTS(000):$0
  Determination of Antineoplastic Drug Exposure in Healthcare
  Workers
FORMS: NONE

OMB NO: 0920-0702    EXPIRATION DATE: 01/31/2008
RESPS:124            HOURS:101            COSTS(000):$0
  Comprehensive Cancer Control: Capacity Assessment
FORMS: NONE

OMB NO: 0920-0703    EXPIRATION DATE: 12/31/2008
RESPS:1,200          HOURS:400            COSTS(000):$0
  Delayed Symptoms Associated with the Convalescent Period of a
  Dengue Infection
FORMS: NONE

OMB NO: 0920-0704    EXPIRATION DATE: 12/31/2006
RESPS:9,016          HOURS:940            COSTS(000):$0
  Assessment of State Early Hearing Detection and Intervention
  Programs (EHDI); A program Operations Evaluation
FORMS: NONE

OMB NO: 0920-0705    EXPIRATION DATE: 12/31/2006
RESPS:5,440          HOURS:382            COSTS(000):$0
  Evaluation of the Poison HELP Campaign to Enhance Public
  Awareness of the National Poison Toll-Free Number, Poison Center
  Access, and Poison Prevention
FORMS: NONE

OMB NO: 0920-0706    EXPIRATION DATE: 12/31/2008
RESPS:49             HOURS:74             COSTS(000):$0
  National Program of Cancer Registries - Annual Program
  Evaluation Instrument (NPCR-APEI)
FORMS: NONE

OMB NO: 0920-0707    EXPIRATION DATE: 01/31/2008
RESPS:1,000          HOURS:250            COSTS(000):$0
  2005 Lead Disclosure Rule Public Awareness Survey
FORMS: NONE

OMB NO: 0920-0708    EXPIRATION DATE: 01/31/2007
RESPS:61             HOURS:105            COSTS(000):$0
  Surveys of Past HIV Prevention Technology Transfer Efforts
FORMS: NONE

OMB NO: 0920-0709    EXPIRATION DATE: 01/31/2009
RESPS:554            HOURS:935            COSTS(000):$0
  Spanish-Language Folic Acid Communication Research and Creative
  Production
FORMS: NONE

OMB NO: 0920-0710    EXPIRATION DATE: 01/31/2007
RESPS:150            HOURS:45             COSTS(000):$0
  Health Communication Planning, Implementation, and Evaluation
  for People with Disabilities
FORMS: NONE

OMB NO: 0920-0714    EXPIRATION DATE: 03/31/2009
RESPS:12,288         HOURS:3,276          COSTS(000):$0
  Evaluation and Assessment of the Effectiveness of Activities
  Supporting Fire Prevention and Safety
FORMS: NONE

OMB NO: 0920-0715    EXPIRATION DATE: 04/30/2009
RESPS:20             HOURS:26             COSTS(000):$0
  Integrating HIV and Other Prevention Services into Reproductive
  Health and Other Community Setting Program Evaluation
FORMS: NONE

OMB NO: 0920-0716    EXPIRATION DATE: 04/30/2009
RESPS:872            HOURS:846            COSTS(000):$0
  Process Evaluation of the Protocol for Assessing Community
  Excellence in Environmental Health (PACE EH)
FORMS: NONE

OMB NO: 0920-0718    EXPIRATION DATE: 10/31/2007
RESPS:5,600          HOURS:3,968          COSTS(000):$0
  Preventive Cardiac Health Care Knowledge, Beliefs, and Behaviors
  in Female Carriers of Duchenne/Becker Muscular Dystrophy
FORMS: NONE

OMB NO: 0920-0720    EXPIRATION DATE: 06/30/2007
RESPS:2,000          HOURS:1,058          COSTS(000):$0
  Economic Evaluation of Walking Behavior in Sedentary Adults Age
  50 Years and Older
FORMS: NONE

OMB NO: 0920-0722    EXPIRATION DATE: 05/31/2007
RESPS:34,478         HOURS:7,253          COSTS(000):$0
  HoME: Household Medkit Evaluation Study
FORMS: NONE

OMB NO: 0920-0723    EXPIRATION DATE: 05/31/2009
RESPS:200            HOURS:250            COSTS(000):$0
  The Continuous Miner Tramming Study Interviews
FORMS: NONE

OMB NO: 0920-0724    EXPIRATION DATE: 08/31/2008
RESPS:15,065         HOURS:1,552          COSTS(000):$0
  The National Intimate Partner and Sexual Violence Survey (NISVS)
FORMS: NONE

OMB NO: 0920-0725    EXPIRATION DATE: 06/30/2007
RESPS:1              HOURS:70             COSTS(000):$0
  Understanding the Community Context of the Diabetes Education in
  Tribal Schools Project
FORMS: NONE

OMB NO: 0920-0726    EXPIRATION DATE: 06/30/2008
RESPS:4,250          HOURS:1,833          COSTS(000):$0
  2006 Hispanic/Latino Adult Tobacco Survey
FORMS: NONE

OMB NO: 0920-0729    EXPIRATION DATE: 06/30/2009
RESPS:2,680          HOURS:547            COSTS(000):$0
  Customer Surveys Generic Clearance for the National Center for
  Health Statistics
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
151 5,183,861 1,324,264 $87,154
Agency for Toxic Substances and Disease Registry
OMB NO: 0923-0002    EXPIRATION DATE: 10/31/2006
RESPS:34             HOURS:17             COSTS(000):$0
  Information Collection Procedures for Requesting Public Health
  Assessments
FORMS: NONE

OMB NO: 0923-0006    EXPIRATION DATE: 08/31/2006
RESPS:1,667          HOURS:834            COSTS(000):$0
  National Exposure Registry
FORMS: NONE

OMB NO: 0923-0007    EXPIRATION DATE: 11/30/2007
RESPS:150            HOURS:25             COSTS(000):$0
  Community Assistance Panels Nomination Form
FORMS: NONE

OMB NO: 0923-0008    EXPIRATION DATE: 05/31/2008
RESPS:9,500          HOURS:6,050          COSTS(000):$0
  Hazardous Substances Emergency Events Surveillance
FORMS: NONE

OMB NO: 0923-0028    EXPIRATION DATE: 02/28/2007
RESPS:4,981          HOURS:415            COSTS(000):$0
  Evaluation of Customer Satisfaction with the Agency for Toxic
  Substances and Disease Registry Internet Home Page and Links
FORMS: NONE

OMB NO: 0923-0035    EXPIRATION DATE: 07/31/2007
RESPS:500            HOURS:41             COSTS(000):$0
  Online Evalution of a GIS Map Server Project with the Migrant
  Clinicians Network
FORMS: NONE

OMB NO: 0923-0036    EXPIRATION DATE: 07/31/2007
RESPS:200            HOURS:150            COSTS(000):$0
  Exposure to Volatile Organic Compounds in Drinking Water and
  Specific Birth Defects and Childhood Cancers at United States
  Marine Corps Base Camp Lejeune, North Carolina.
FORMS: NONE

OMB NO: 0923-0040    EXPIRATION DATE: 07/31/2009
RESPS:750            HOURS:375            COSTS(000):$0
  NCEH/ATSDR Exposure Investigations (EI)
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
8 17,782 7,907 $0
National Institutes of Health
OMB NO: 0925-0001    EXPIRATION DATE: 09/30/2007
RESPS:122,000        HOURS:1,032,439      COSTS(000):$500
  Research and Research Training Grant Applications and Related
  Forms
FORMS: PHS-398 2590 2271 3734 HHS-568

OMB NO: 0925-0002    EXPIRATION DATE: 10/31/2008
RESPS:51,822         HOURS:124,034        COSTS(000):$18
  Individual Ruth L. Kirschstein National Research Service Award
  Applications and Related Forms
FORMS: 416-5 416-7 416-9 6031 6031-1 PHS-416-1

OMB NO: 0925-0046    EXPIRATION DATE: 10/31/2006
RESPS:13,780         HOURS:2,010          COSTS(000):$0
  Pretesting of NCI's Office of Communications Messages
FORMS: NONE

OMB NO: 0925-0208    EXPIRATION DATE: 11/30/2006
RESPS:405,900        HOURS:1,951          COSTS(000):$0
  The National Cancer Institute Cancer Information Service
  Demographic Customer Service Data Collection
FORMS: NONE

OMB NO: 0925-0216    EXPIRATION DATE: 12/31/2007
RESPS:12,202         HOURS:6,886          COSTS(000):$0
  The Framingham Study
FORMS: NONE

OMB NO: 0925-0240    EXPIRATION DATE: 11/30/2007
RESPS:66,339         HOURS:3,378          COSTS(000):$0
  Drug Accountability Record
FORMS: NIH-2564 NIH-2564-1

OMB NO: 0925-0281    EXPIRATION DATE: 02/28/2007
RESPS:13,640         HOURS:2,319          COSTS(000):$0
  The Atherosclerosis Risk in Communities Study (ARIC)
FORMS: NONE

OMB NO: 0925-0299    EXPIRATION DATE: 08/31/2006
RESPS:21,545         HOURS:11,369         COSTS(000):$0
  NIH Intramural Research Training Award Program Application
FORMS: NONE

OMB NO: 0925-0334    EXPIRATION DATE: 09/30/2007
RESPS:12,582         HOURS:868            COSTS(000):$0
  The Cardiovascular, Heart Diseases Health Study
FORMS: NONE

OMB NO: 0925-0348    EXPIRATION DATE: 08/31/2006
RESPS:36             HOURS:360            COSTS(000):$0
  Hazardous Waste Worker Training
FORMS: NONE

OMB NO: 0925-0361    EXPIRATION DATE: 06/30/2008
RESPS:12,468         HOURS:29,038         COSTS(000):$0
  National Institutes of Health Loan Repayment Programs
FORMS: 2674-1-NO.7 2674-7 2674-2-NO.8 2674-8 2674-3-NO.9 2674-9
2674-4-NO.10 2674-10 2674-5-NO.11 2674-11

OMB NO: 0925-0368    EXPIRATION DATE: 04/30/2009
RESPS:95,000         HOURS:11,106         COSTS(000):$0
  American Stop Smoking Intervention Study for Cancer Prevention
  Final Eval.: "Tobacco Use Supplement to the 1998-99 Current
  Population Survey"
FORMS: NONE

OMB NO: 0925-0378    EXPIRATION DATE: 08/31/2007
RESPS:200            HOURS:114            COSTS(000):$0
  Application for the Pharmacology Research Associate Program
FORMS: NIH-2721-1 NIH-2721-2

OMB NO: 0925-0405    EXPIRATION DATE: 02/28/2007
RESPS:59,200         HOURS:29,500         COSTS(000):$0
  Generic Clearance to Collect Medical Outcome and Risk Factor
  Data from a Cohort of U.S. Radiologic Technologists
FORMS: NONE

OMB NO: 0925-0406    EXPIRATION DATE: 10/31/2008
RESPS:24,733         HOURS:44,270         COSTS(000):$0
  Agricultural Health Study (A Prospective Cohort Study of Cancer
  and Other Diseases Among Men and Women in Agriculture
FORMS: NONE

OMB NO: 0925-0407    EXPIRATION DATE: 10/31/2008
RESPS:1              HOURS:23,086         COSTS(000):$0
  Prostate, Lung, Colorectal and Overian (PLCO) Cancer Screening
  Trial
FORMS: NONE

OMB NO: 0925-0414    EXPIRATION DATE: 05/31/2009
RESPS:88,131         HOURS:18,319         COSTS(000):$0
  Women's Health Initiative Observational Study
FORMS: NONE

OMB NO: 0925-0417    EXPIRATION DATE: 11/30/2008
RESPS:42,800         HOURS:232,000        COSTS(000):$4
  Responsibility of Applicants for Promoting Objectivity in
  Reserch for which Public Health Service Funding is Sought
FORMS: NONE

OMB NO: 0925-0424    EXPIRATION DATE: 08/31/2008
RESPS:16,481         HOURS:16,481         COSTS(000):$0
  National Institutes of Health Construction Grants
FORMS: NONE

OMB NO: 0925-0438    EXPIRATION DATE: 12/31/2007
RESPS:1,580          HOURS:2,033          COSTS(000):$0
  National Institutes of Health Undergraduate Scholarship Program
  for Individuals from Disadvantaged Backgrounds
FORMS: NIH-2762-1 NIH-2762-2 NIH-2762-3 NIH-2762-4 NIH-2762-5

OMB NO: 0925-0454    EXPIRATION DATE: 01/31/2008
RESPS:862            HOURS:396            COSTS(000):$0
  Case-Cohort Study of Cancer and Related Disorders Among
  Benzene-Exposed Workers in China
FORMS: NONE

OMB NO: 0925-0458    EXPIRATION DATE: 06/30/2007
RESPS:2,965          HOURS:2,671          COSTS(000):$0
  Satisfaction Surveys of Customers and Other Partners
FORMS: NONE

OMB NO: 0925-0465    EXPIRATION DATE: 10/31/2006
RESPS:2,441          HOURS:814            COSTS(000):$0
  Re-contacting Participants in the Observing Protein and Energy
  Nutrition (Re-OPEN) Study
FORMS: NONE

OMB NO: 0925-0474    EXPIRATION DATE: 09/30/2007
RESPS:2,100          HOURS:693            COSTS(000):$0
  Generic Clearance for Satisfaction Surveys of Customers
FORMS: NONE

OMB NO: 0925-0475    EXPIRATION DATE: 11/30/2008
RESPS:400            HOURS:148            COSTS(000):$0
  Training Tomorrow's Scientists: Linking Minorities and Mentors
  Through the Web
FORMS: NONE

OMB NO: 0925-0476    EXPIRATION DATE: 07/31/2009
RESPS:19,758         HOURS:2,680          COSTS(000):$0
  Request for Generic Clearance to Conduct Voluntary
  Customer/Partner Surveys
FORMS: NONE

OMB NO: 0925-0479    EXPIRATION DATE: 09/30/2006
RESPS:51             HOURS:18             COSTS(000):$0
  Request for Clearance to Conduct Voluntary Customer Satisfaction
  Surveys
FORMS: NONE

OMB NO: 0925-0480    EXPIRATION DATE: 11/30/2006
RESPS:12,000         HOURS:2,000          COSTS(000):$0
  NIDDK Information Clearinghouse Customer Satisfaction Survey
FORMS: NONE

OMB NO: 0925-0483    EXPIRATION DATE: 06/30/2009
RESPS:733            HOURS:122            COSTS(000):$0
  Environmental Factors in the Development of Polycystic Ovary
  Syndrome
FORMS: NONE

OMB NO: 0925-0484    EXPIRATION DATE: 02/28/2007
RESPS:43,093         HOURS:43,093         COSTS(000):$0
  Wave 2 National Epidemiologic Survey on Alcohol and Related
  Conditions (NESARC)
FORMS: NONE

OMB NO: 0925-0486    EXPIRATION DATE: 05/31/2007
RESPS:104,000        HOURS:8,684          COSTS(000):$0
  Evaluation of User Satisfaction with NIH Internet Sites
FORMS: NONE

OMB NO: 0925-0491    EXPIRATION DATE: 05/31/2007
RESPS:600            HOURS:300            COSTS(000):$0
  The Jackson Heart Study: Annual Follow-up with Third Party
  Respondents
FORMS: NONE

OMB NO: 0925-0493    EXPIRATION DATE: 10/31/2007
RESPS:555            HOURS:42             COSTS(000):$0
  The Multi-Ethnic Study of Atherosclerosis (MESA)
FORMS: NONE

OMB NO: 0925-0501    EXPIRATION DATE: 11/30/2007
RESPS:3,030          HOURS:1,060          COSTS(000):$0
  Graduate Student Training Programs Application
FORMS: NONE

OMB NO: 0925-0503    EXPIRATION DATE: 12/31/2008
RESPS:500            HOURS:500            COSTS(000):$0
  Assessment of the Use of Special Funding for Research on Type 1
  Diabetes
FORMS: NONE

OMB NO: 0925-0520    EXPIRATION DATE: 08/31/2006
RESPS:4,882          HOURS:387            COSTS(000):$0
  National Center for Complementary and Alternative Medicine
  (NCCAM) Customer Service Data Collection
FORMS: NONE

OMB NO: 0925-0522    EXPIRATION DATE: 08/31/2006
RESPS:67,527         HOURS:63,438         COSTS(000):$0
  The Sister Study: Environmental and Genetic Risk Factors for
  Breast Cancer
FORMS: NONE

OMB NO: 0925-0523    EXPIRATION DATE: 09/30/2006
RESPS:2              HOURS:2,887          COSTS(000):$0
  Aggression Prevention Among High-Risk Early Adolescents
FORMS: NONE

OMB NO: 0925-0524    EXPIRATION DATE: 11/30/2006
RESPS:986            HOURS:441            COSTS(000):$0
  Assessment for Minority Research Training Programs
FORMS: NONE

OMB NO: 0925-0525    EXPIRATION DATE: 12/31/2006
RESPS:8,602          HOURS:3,267          COSTS(000):$0
  Effectiveness of the National Institute on Drug Abuse's
  Publications Project
FORMS: NONE

OMB NO: 0925-0526    EXPIRATION DATE: 02/28/2007
RESPS:7,642          HOURS:910            COSTS(000):$0
  Customer Satisfaction with Educational Programs and Products of
  the National Cancer Institute
FORMS: NONE

OMB NO: 0925-0527    EXPIRATION DATE: 06/30/2007
RESPS:750            HOURS:248            COSTS(000):$0
  Career Survey of Biomedical Researchers
FORMS: NONE

OMB NO: 0925-0528    EXPIRATION DATE: 07/31/2007
RESPS:500            HOURS:184            COSTS(000):$0
  Physicians' Experience of Ethical Dilemmas and Resource
  Allocation
FORMS: NONE

OMB NO: 0925-0530    EXPIRATION DATE: 06/30/2007
RESPS:2,440          HOURS:712            COSTS(000):$0
  National Center for Complementary and Alternative Medicine
  (NCCAM) Communications Program Planning and Evaluation
FORMS: NONE

OMB NO: 0925-0531    EXPIRATION DATE: 09/30/2007
RESPS:1,072          HOURS:1,072          COSTS(000):$0
  The Impact of A Decade of the Fogarty International Research
  Collaboration Award (FIRCA)
FORMS: NONE

OMB NO: 0925-0532    EXPIRATION DATE: 10/31/2007
RESPS:13,625         HOURS:1,872          COSTS(000):$0
  NICHD Research Partner Satisfaction Surveys
FORMS: NONE

OMB NO: 0925-0534    EXPIRATION DATE: 08/31/2007
RESPS:3,500          HOURS:1,200          COSTS(000):$0
  NIH Customer/Partner Satisfaction Survey of Modification in
  Procedures for Applications and Awards of Research Project Grants
FORMS: NONE

OMB NO: 0925-0535    EXPIRATION DATE: 11/30/2007
RESPS:1,875          HOURS:625            COSTS(000):$0
  Obstetrician-Gynecologists' Knowledge and Practice Patterns with
  Regard to Hormone Therapy
FORMS: NONE

OMB NO: 0925-0536    EXPIRATION DATE: 09/30/2007
RESPS:185            HOURS:157            COSTS(000):$0
  Career Survey of Science-Oriented Scholars
FORMS: NONE

OMB NO: 0925-0538    EXPIRATION DATE: 11/30/2007
RESPS:10,489         HOURS:4,036          COSTS(000):$0
  Health Information National Trends Survey II (HINTS)
FORMS: NONE

OMB NO: 0925-0540    EXPIRATION DATE: 12/31/2007
RESPS:2,568          HOURS:759            COSTS(000):$0
  Pilot Study Evaluating the Cross-Cultural Equivalency of the
  Tobacco Use Supplement to the Current Population Survey
FORMS: NONE

OMB NO: 0925-0541    EXPIRATION DATE: 12/31/2007
RESPS:600            HOURS:150            COSTS(000):$0
  Improving Media Coverage of Cancer: A Survey of Science and
  Health Reporters
FORMS: NONE

OMB NO: 0925-0542    EXPIRATION DATE: 04/30/2008
RESPS:479            HOURS:434            COSTS(000):$0
  Brain Power! The NIDA Junior Scientist Program and the Companion
  Program, Brain Power! Challenge
FORMS: NONE

OMB NO: 0925-0543    EXPIRATION DATE: 03/31/2008
RESPS:1,000          HOURS:15,380         COSTS(000):$0
  Longitudinal Investigation of Fertility and the Environment
FORMS: NONE

OMB NO: 0925-0547    EXPIRATION DATE: 06/30/2008
RESPS:80             HOURS:40             COSTS(000):$0
  Outcome Evaluation of the Small Grants Program Research in
  Cancer Control
FORMS: NONE

OMB NO: 0925-0548    EXPIRATION DATE: 06/30/2008
RESPS:400            HOURS:132            COSTS(000):$0
  Survey of Colorectal Cancer Screening Policies, Programs and
  Systems in U.S. Health Plans
FORMS: NONE

OMB NO: 0925-0549    EXPIRATION DATE: 09/30/2008
RESPS:1              HOURS:88             COSTS(000):$0
  Evaluation of NCI's Central Institutional Review Board to
  Improve Cancer Clinical Trials System.
FORMS: NONE

OMB NO: 0925-0550    EXPIRATION DATE: 07/31/2008
RESPS:275            HOURS:706            COSTS(000):$0
  Inventory and Evaluation of Clinical Research Networks
FORMS: NONE

OMB NO: 0925-0551    EXPIRATION DATE: 11/30/2008
RESPS:11,735         HOURS:1,155          COSTS(000):$0
  The Effectiveness of the NIH Curriculum Supplements Programs
FORMS: NONE

OMB NO: 0925-0552    EXPIRATION DATE: 11/30/2008
RESPS:1              HOURS:400            COSTS(000):$0
  National Diabetes Education Program Evaluation Survey of the
  Public
FORMS: NONE

OMB NO: 0925-0554    EXPIRATION DATE: 12/31/2008
RESPS:150            HOURS:50             COSTS(000):$0
  Survey of Institutional Program Directors of NIGMS MORE Programs
FORMS: NONE

OMB NO: 0925-0557    EXPIRATION DATE: 01/31/2009
RESPS:14,790         HOURS:10,875         COSTS(000):$0
  Health Behaviors in School-Age Children Survey
FORMS: NONE

OMB NO: 0925-0558    EXPIRATION DATE: 04/30/2009
RESPS:1,060          HOURS:662            COSTS(000):$0
  Discovering the Science of Alcohol Program Field Test Data
  Collection Instruments
FORMS: NONE

OMB NO: 0925-0560    EXPIRATION DATE: 03/31/2009
RESPS:5,475          HOURS:2,300          COSTS(000):$0
  5 A Day Customized Survey
FORMS: NONE

OMB NO: 0925-0561    EXPIRATION DATE: 05/31/2009
RESPS:450            HOURS:756            COSTS(000):$0
  Use of In-Home Test Kits in Dust Mite Allergen Reduction
FORMS: NONE

OMB NO: 0925-0562    EXPIRATION DATE: 07/31/2009
RESPS:2,500          HOURS:835            COSTS(000):$0
  National Survey of Primary Care Physicians for Breast, Cervical,
  Colorectal, and Lung Cancer Screening
FORMS: NONE

OMB NO: 0925-0564    EXPIRATION DATE: 07/31/2009
RESPS:1,268          HOURS:480            COSTS(000):$0
  Brain Train 4 Kids
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
67 1,420,437 1,771,420 $522
Substance Abuse and Mental Health Services Administration
OMB NO: 0930-0074    EXPIRATION DATE: 04/30/2007
RESPS:79             HOURS:14             COSTS(000):$0
  Obligated Service for Mental Health Traineeships: Regulations
  and Forms
FORMS: SMA-111-2

OMB NO: 0930-0078    EXPIRATION DATE: 12/31/2008
RESPS:26,829         HOURS:111,938        COSTS(000):$0
  Drug Abuse Warning Network (DAWN)
FORMS: NONE

OMB NO: 0930-0080    EXPIRATION DATE: 08/31/2007
RESPS:60             HOURS:31,880         COSTS(000):$0
  Substance Abuse Prevention and Treatment Block Grant (SAPTBG)
  Regulations (45 CFR Part 96) and FY 2005-2007 Application Format
FORMS: NONE

OMB NO: 0930-0092    EXPIRATION DATE: 08/31/2007
RESPS:1,760,526      HOURS:353,349        COSTS(000):$87
  Confidentiality of Alcohol and Drug Abuse Patient Records - 42
  CFR Part 2
FORMS: NONE

OMB NO: 0930-0093    EXPIRATION DATE: 11/30/2006
RESPS:52             HOURS:38             COSTS(000):$0
  Annual Census of Patient Characteristics in State and County
  Mental Hospital Inpatient Services
FORMS: SMA-102

OMB NO: 0930-0104    EXPIRATION DATE: 09/30/2007
RESPS:5              HOURS:3              COSTS(000):$0
  Community Mental Health Centers Construction Grantee Checklist
  Form and Regulations
FORMS: SMA-101

OMB NO: 0930-0106    EXPIRATION DATE: 11/30/2008
RESPS:23,125         HOURS:6,491          COSTS(000):$0
  Drug and Alcohol Services Information System
FORMS: NONE

OMB NO: 0930-0110    EXPIRATION DATE: 01/31/2007
RESPS:182,250        HOURS:86,877         COSTS(000):$0
  2006 National Survey on Drug Use and Health (NSDUH)
FORMS: NONE

OMB NO: 0930-0119    EXPIRATION DATE: 07/31/2008
RESPS:9,690          HOURS:14,463         COSTS(000):$0
  2004 Inventory of Mental Health Organizations, and General
  Hospital Mental Health Services, and Managed Care Organizations
  Survey (IMHO)
FORMS: NONE

OMB NO: 0930-0158    EXPIRATION DATE: 08/31/2006
RESPS:28,384,168     HOURS:1,788,089      COSTS(000):$2,071
  Mandatory Guidelines for Federal Workplace Drug Testing Program
FORMS: NONE

OMB NO: 0930-0163    EXPIRATION DATE: 04/30/2007
RESPS:60             HOURS:960            COSTS(000):$0
  Substance Abuse Prevention and Treatment Block Grant Reguations
  - 45 CFR Part 96
FORMS: NONE

OMB NO: 0930-0168    EXPIRATION DATE: 07/31/2007
RESPS:59             HOURS:17,265         COSTS(000):$0
  Community Mental Health Services Block Grant Application
  Guidance and Instructions, FY 2005-2007
FORMS: NONE

OMB NO: 0930-0169    EXPIRATION DATE: 05/31/2007
RESPS:114            HOURS:2,166          COSTS(000):$0
  Protection and Advoccy of Individuals With Mental Illness
  (PAIMI) Annual Program Performance Report
FORMS: NONE

OMB NO: 0930-0172    EXPIRATION DATE: 02/28/2007
RESPS:142            HOURS:184            COSTS(000):$0
  Protection and Advocacy for Individuals with Mental Illness
  Regulations -- 45 CFR Part 51
FORMS: NONE

OMB NO: 0930-0195    EXPIRATION DATE: 11/30/2007
RESPS:12,600         HOURS:1,843          COSTS(000):$0
  Participant Feedback Forms for the Mental Health Care Provider
  Education (MHCPE) in the HIV/AIDS Program
FORMS: NONE

OMB NO: 0930-0196    EXPIRATION DATE: 06/30/2007
RESPS:11,700         HOURS:9,290          COSTS(000):$0
  Pretesting of Substance Abuse Prevention and Treatment and
  Mental Health Services Communications Messages
FORMS: NONE

OMB NO: 0930-0197    EXPIRATION DATE: 12/31/2007
RESPS:30,150         HOURS:15,225         COSTS(000):$0
  Voluntary Customer Satisfaction Surveys to Implement Executive
  Order 12862 in the Substance Abuse and Mental Health Services
  Administration (SAMHSA)
FORMS: NONE

OMB NO: 0930-0205    EXPIRATION DATE: 07/31/2009
RESPS:506            HOURS:14,398         COSTS(000):$0
  Annual Reports for Projects for Assistance in Transition from
  Homelessness (PATH)
FORMS: NONE

OMB NO: 0930-0206    EXPIRATION DATE: 09/30/2006
RESPS:9,677          HOURS:2,035          COSTS(000):$2,524
  Opioid Drugs in Maintenance and Detoxification Treatment of
  Opiate Addiction - 42 CFR Part 8
FORMS: SMA-162 SMA-163 SMA-168

OMB NO: 0930-0208    EXPIRATION DATE: 01/31/2007
RESPS:337,810        HOURS:24,960         COSTS(000):$0
  Government Performance and Results Act Client/Participant
  Outcome Measures
FORMS: NONE

OMB NO: 0930-0209    EXPIRATION DATE: 11/30/2006
RESPS:76,431         HOURS:14,040         COSTS(000):$0
  National Evaluation of the Comprehensive Community Mental Health
  Services for Children and Their Families Program: Phase Three
FORMS: NONE

OMB NO: 0930-0216    EXPIRATION DATE: 10/31/2006
RESPS:23,260         HOURS:7,010          COSTS(000):$0
  National Cross-Site Assessment of Addiction Technology Transfer
  Centers (ATTC) Network
FORMS: NONE

OMB NO: 0930-0222    EXPIRATION DATE: 08/31/2007
RESPS:59             HOURS:1,062          COSTS(000):$0
  Substance Abuse Prevention and Treatment Block Grant Synar
  Report Format, FY 2005-2007
FORMS: NONE

OMB NO: 0930-0226    EXPIRATION DATE: 11/30/2007
RESPS:1,446          HOURS:8,151          COSTS(000):$0
  Protocols for the Cross-Site Process Evaluation of the State
  incentive Grant (SIG) Program
FORMS: NONE

OMB NO: 0930-0229    EXPIRATION DATE: 07/31/2008
RESPS:6              HOURS:18             COSTS(000):$0
  Emergency Response Grants - 42 CFR Part 51
FORMS: NONE

OMB NO: 0930-0230    EXPIRATION DATE: 12/31/2008
RESPS:246            HOURS:419            COSTS(000):$0
  National Outcome Measures for Substance Abuse Prevention
FORMS: NONE

OMB NO: 0930-0232    EXPIRATION DATE: 03/31/2008
RESPS:3,120          HOURS:780            COSTS(000):$0
  Workplace Helpline Call Record Form
FORMS: NONE

OMB NO: 0930-0234    EXPIRATION DATE: 03/31/2009
RESPS:2,050          HOURS:135            COSTS(000):$0
  Notification of Intent to Use Schedule III, IV, or V Opioid
  Drugs for the Maintenance and Detoxification Treatment of Opiate
  Addiction
FORMS: NONE

OMB NO: 0930-0242    EXPIRATION DATE: 09/30/2006
RESPS:319,906        HOURS:16,208         COSTS(000):$56
  Regulations to Implement SAMHSA's Charitable Choice Statutory
  Provisions: 42 CFR Parts 54 and 54a
FORMS: SMA-170

OMB NO: 0930-0248    EXPIRATION DATE: 10/31/2006
RESPS:789            HOURS:1,123          COSTS(000):$0
  Evaluation of Program Rehabilitation and Restitution (PRR)
FORMS: NONE

OMB NO: 0930-0249    EXPIRATION DATE: 10/31/2006
RESPS:1,788          HOURS:928            COSTS(000):$0
  Family Treatment Drug Court Evaluation
FORMS: NONE

OMB NO: 0930-0252    EXPIRATION DATE: 12/31/2006
RESPS:106            HOURS:53             COSTS(000):$0
  Safe Schools/Healthy Students Sustainability Study
FORMS: NONE

OMB NO: 0930-0255    EXPIRATION DATE: 08/31/2007
RESPS:500            HOURS:750            COSTS(000):$0
  SAMHSA Application for Peer Grant Reviewers
FORMS: NONE

OMB NO: 0930-0257    EXPIRATION DATE: 04/30/2007
RESPS:51,293         HOURS:25,262         COSTS(000):$0
  National Evaluation of the Comprehensive Community Mental Health
  Services for Children and Their Families Program: Phase Four
FORMS: NONE

OMB NO: 0930-0258    EXPIRATION DATE: 11/30/2007
RESPS:2,000          HOURS:334            COSTS(000):$0
  Assessment of the Reach Out Now! Teach-In Initiative
FORMS: NONE

OMB NO: 0930-0261    EXPIRATION DATE: 10/31/2007
RESPS:7,354          HOURS:4,886          COSTS(000):$0
  National Surey on Drug Use and Health_ Methodological Field Tests
FORMS: NONE

OMB NO: 0930-0262    EXPIRATION DATE: 11/30/2007
RESPS:1,833          HOURS:770            COSTS(000):$0
  Evaluation of Buprenorphine Waiver Program: Waivered Physicians
  Survey
FORMS: NONE

OMB NO: 0930-0265    EXPIRATION DATE: 05/31/2008
RESPS:51             HOURS:51             COSTS(000):$0
  Survey of Medicaid Directors Regarding Medicaid Mental Health
  Services and Policy
FORMS: NONE

OMB NO: 0930-0266    EXPIRATION DATE: 05/31/2008
RESPS:398,226        HOURS:81,318         COSTS(000):$0
  Access to Recovery (ATR) Program
FORMS: NONE

OMB NO: 0930-0269    EXPIRATION DATE: 09/30/2007
RESPS:1,338          HOURS:335            COSTS(000):$0
  Cross-Site Accountability Assessment of the Residential
  Treatment for Prgnant and Postpartum Women and Their Minor
  Children Program (PPW)
FORMS: NONE

OMB NO: 0930-0270    EXPIRATION DATE: 09/30/2008
RESPS:16,700         HOURS:741            COSTS(000):$0
  Toolkit Protocol for the Crisis Counseling Assistance and
  Training Program (CCP)
FORMS: NONE

OMB NO: 0930-0271    EXPIRATION DATE: 11/30/2008
RESPS:1,274          HOURS:9,702          COSTS(000):$0
  Initiative to Reduce/Eliminate Seclusion and Restraint: 8 State
  Incentive Grants and Coordinating Center
FORMS: NONE

OMB NO: 0930-0272    EXPIRATION DATE: 12/31/2008
RESPS:60             HOURS:60             COSTS(000):$0
  Survey of Single State Authorities Regarding the HIV Set-Aside
  of the Substance Abuse Prevention and Treatment Block Grant
FORMS: NONE

OMB NO: 0930-0274    EXPIRATION DATE: 02/28/2009
RESPS:366            HOURS:264            COSTS(000):$0
  Monitoring of National Suicide Prevention Lifeline Form
FORMS: NONE

OMB NO: 0930-0275    EXPIRATION DATE: 02/28/2009
RESPS:720            HOURS:598            COSTS(000):$0
  Evaluation of Networking Suicide Prevention Hotlines Followup
  Assessment
FORMS: NONE

OMB NO: 0930-0276    EXPIRATION DATE: 04/30/2009
RESPS:24             HOURS:11,322         COSTS(000):$0
  Cross-Site Evaluation of the National Child Traumatic Stress
  Initiative (NCTSI)
FORMS: NONE

OMB NO: 0930-0277    EXPIRATION DATE: 05/31/2009
RESPS:26,894         HOURS:1,373          COSTS(000):$0
  Targeted Capacity Expansion Grants for Jail Diversion Programs
FORMS: NONE

OMB NO: 0930-0278    EXPIRATION DATE: 07/31/2009
RESPS:430            HOURS:724            COSTS(000):$0
  Evaluation of the Policy Academies on Chronic Homelessness
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
48 31,727,872 2,669,885 $4,738
Agency for Health Care Research and Quality
OMB NO: 0935-0106    EXPIRATION DATE: 01/31/2008
RESPS:103,400        HOURS:16,356         COSTS(000):$515,732
  Voluntary Customer Surveys Generic Clearance for the Agency for
  Healthcare Research and Quality
FORMS: NONE

OMB NO: 0935-0110    EXPIRATION DATE: 02/29/2008
RESPS:36,264         HOURS:20,922         COSTS(000):$0
  2004 - 2006 Medical Expenditure Panel Survey - Insurance
  Componenet (MEPS-IC)
FORMS: NONE

OMB NO: 0935-0117    EXPIRATION DATE: 02/28/2007
RESPS:285            HOURS:87             COSTS(000):$0
  Surveys of Employee Benefit Managers of Large National Employers
  Concerning Dissemination Effectiveness of Health Services
  Research Information
FORMS: NONE

OMB NO: 0935-0118    EXPIRATION DATE: 02/28/2007
RESPS:83,700         HOURS:249,848        COSTS(000):$0
  Medical Expenditure Panel Survey Household Component and Medical
  Provider Component (MEPS-HC and MEPS-MPC 2004 and 2005)
FORMS: NONE

OMB NO: 0935-0122    EXPIRATION DATE: 11/30/2007
RESPS:1,500          HOURS:250            COSTS(000):$0
  AHRQ Grants Reporting System
FORMS: NONE

OMB NO: 0935-0124    EXPIRATION DATE: 01/31/2008
RESPS:10,500         HOURS:5,200          COSTS(000):$0
  Questionnaire and Data Collection Testing, Evaluation, and
  Research for the Agency for Healthcare Research and Quality
FORMS: NONE

OMB NO: 0935-0125    EXPIRATION DATE: 07/31/2008
RESPS:960            HOURS:403            COSTS(000):$0
  National Study of the Hospital Adverse Event Reporting Survey
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
7 236,609 293,066 $515,732
Office of Assistant Secretary for Health
OMB NO: 0937-0025    EXPIRATION DATE: 09/30/2006
RESPS:10,000         HOURS:4,000          COSTS(000):$0
  Reference Request for Applicants to the U.S. Public Health
  Service Commissioned Corps
FORMS: PHS-50 PHS-1813

OMB NO: 0937-0166    EXPIRATION DATE: 08/31/2006
RESPS:50,000         HOURS:50,000         COSTS(000):$0
  42 C.F.R. Subpart B: Sterilization of Persons in Federally
  Assisted Family Planning Projects
FORMS: NONE

OMB NO: 0937-0191    EXPIRATION DATE: 02/29/2008
RESPS:22             HOURS:4,400          COSTS(000):$0
  Application Packets for Real Property for Public Health Purposes
FORMS: HHS-696

OMB NO: 0937-0198    EXPIRATION DATE: 03/31/2009
RESPS:3,800          HOURS:400            COSTS(000):$0
  Public Health Service Policies on Research Misconduct (42 CFR
  Part 93)
FORMS: PHS-6349

OMB NO: 0937-0200    EXPIRATION DATE: 06/30/2007
RESPS:73,560         HOURS:220,980        COSTS(000):$0
  HHS Payment Management System Forms PMS-270 - Request for
  Advance or Reimbursement and PMS-272 - Federal Cast Transaction
  Report
FORMS: 270 272

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
5 137,382 279,780 $0
Centers for Medicare and Medicaid Services
OMB NO: 0938-0008    EXPIRATION DATE: 05/31/2009
RESPS:957,204,707    HOURS:46,383,364     COSTS(000):$0
  Health Insurance Common Claims Form and Supporting Regulations
  at 42 CFR Part 424, Subpart C
FORMS: CMS-1490S CMS-1490U CMS-1500(12-90)

OMB NO: 0938-0022    EXPIRATION DATE: 04/30/2007
RESPS:7,310          HOURS:1,311,060      COSTS(000):$0
  Home Health Agency Cost Report and Supporting Regulations in 42
  CFR 413.20, 413.24, 413.106
FORMS: CMS-1728-94

OMB NO: 0938-0023    EXPIRATION DATE: 07/31/2008
RESPS:200            HOURS:50             COSTS(000):$0
  Attending Physicians Statement and Documentation of Medicare
  Emergency and Supporting Regulations in 42 CFR 424.103
FORMS: CMS-1771

OMB NO: 0938-0025    EXPIRATION DATE: 08/31/2006
RESPS:14,000         HOURS:5,833          COSTS(000):$0
  Request for Termination of Premium-Hospital and/or Supplementary
  Medical Insurance and Supporting Regulations in 42 CFR 406.28 &
  407.27
FORMS: CMS-1763

OMB NO: 0938-0027    EXPIRATION DATE: 02/28/2009
RESPS:98             HOURS:172            COSTS(000):$0
  Request for Certification as Supplier of Portable X-Ray and
  Portable X-Ray Survey Report Form
FORMS: 1880-1882

OMB NO: 0938-0033    EXPIRATION DATE: 05/31/2007
RESPS:6,860,000      HOURS:1,629,000      COSTS(000):$0
  Request for Review of Part B Medicare Claim and Supporting
  Regulations in 42 CFR Sec. 405.807
FORMS: CMS-1964

OMB NO: 0938-0035    EXPIRATION DATE: 07/31/2009
RESPS:6,600          HOURS:2,366          COSTS(000):$0
  Social Security Office (SSO) Report of State Buy-in Problems
FORMS: CMS-1957

OMB NO: 0938-0037    EXPIRATION DATE: 01/31/2008
RESPS:618            HOURS:61,800         COSTS(000):$0
  Outpatient Rehabilitation Cost Report and Supporting Regulations
  in 42 CFR 413.20 and 413.24
FORMS: CMS-2088-92

OMB NO: 0938-0041    EXPIRATION DATE: 11/30/2006
RESPS:17,350         HOURS:6,446          COSTS(000):$0
  Third Party Premium Billing Request and Supporting Regulations
  in 42 CFR 408.6 and 408.202
FORMS: CMS-2384

OMB NO: 0938-0042    EXPIRATION DATE: 04/30/2007
RESPS:240,000        HOURS:60,010         COSTS(000):$0
  Request for Medicare Payment -- Ambulance and Supporting
  Regulations in 42 CFR Sections 410.1, 410.40, 424.124, 424.601,
  414.605, 414.610, 414.615, 414.620, 414.625, and 424.32
FORMS: CMS-1491

OMB NO: 0938-0045    EXPIRATION DATE: 11/30/2006
RESPS:60,000         HOURS:15,000         COSTS(000):$0
  Request for Reconsideration of Part A Medicare Claim and
  Supporting Regulations in 42 CFR, 405.711
FORMS: CMS-2649

OMB NO: 0938-0046    EXPIRATION DATE: 06/30/2007
RESPS:100,000        HOURS:75,000         COSTS(000):$0
  End Stage Renal Disease Medical Evidence Report Medicare
  Entitlement and/or Patient Registration and Supporting
  Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts....
FORMS: CMS-2728-ESRD

OMB NO: 0938-0050    EXPIRATION DATE: 05/31/2008
RESPS:6,111          HOURS:4,046,782      COSTS(000):$0
  Hospitals and Health Care Complex Cost Report
FORMS: 2552-96

OMB NO: 0938-0062    EXPIRATION DATE: 01/31/2007
RESPS:177,271,815    HOURS:6,841,538      COSTS(000):$0
  Intermediate Care Facility for the Mentally Retarded or Persons
  with Related Conditions ICF/MR Survey Report Form (3070G-I) and
  Supporting Regulations at 42CFR 442.30, 483.410, 483.420,...
FORMS: CMS-3070G-I

OMB NO: 0938-0065    EXPIRATION DATE: 10/31/2008
RESPS:495            HOURS:866            COSTS(000):$0
  Outpatient Physical Therapy Speech Pathology Survey Report and
  Supporting Regulation in 42 CFR 485.701-485.729
FORMS: 1856 1893

OMB NO: 0938-0067    EXPIRATION DATE: 06/30/2008
RESPS:224            HOURS:18,144         COSTS(000):$0
  Quarterly Medicaid Statement of Expenditures for the Medical
  Assistance Program
FORMS: CMS-64

OMB NO: 0938-0074    EXPIRATION DATE: 12/31/2008
RESPS:698            HOURS:1,222          COSTS(000):$0
  Request for Certification as Rural Health Clinic and Rural
  Health Clinic Survey Report Form and Supporting Regulations in
  42 CFR 491.1-491.11
FORMS: 0029-0030

OMB NO: 0938-0080    EXPIRATION DATE: 10/31/2006
RESPS:60,000         HOURS:26,000         COSTS(000):$0
  Application for Health Insurance Benefits Under Medicare for
  Individual with Chronic Renal Disease and Supporting Regulations
  in 42 CFR 406.7 and .13
FORMS: CMS-43

OMB NO: 0938-0086    EXPIRATION DATE: 12/31/2008
RESPS:125,000        HOURS:62,500         COSTS(000):$0
  Disclosure of Ownership and Financial Control Interest Statement
  and Supporting Regulations Contained in 42 CFR 420.200-.206 and
  455.100-.106
FORMS: CMS-1513

OMB NO: 0938-0101    EXPIRATION DATE: 09/30/2008
RESPS:224            HOURS:7,616          COSTS(000):$0
  Medicaid Program Budget Report, and Supporting Regs.
FORMS: CMS-37

OMB NO: 0938-0102    EXPIRATION DATE: 08/31/2006
RESPS:108            HOURS:4,860          COSTS(000):$0
  Organ Procurement Organization/Histcompatibility Laboratory
  Statement of Reimbursable Costs, Manual Instructions and
  Supporting Regulations Contained in 42 CFR 413.20 and 413.24
FORMS: CMS-216

OMB NO: 0938-0107    EXPIRATION DATE: 06/30/2008
RESPS:3,000          HOURS:150,000        COSTS(000):$0
  Independent Rural Health Center/Freestanding Federally Qualified
  Health Center Cost Report and Supp. Regs in 42 CFR Sections
  413.20 and 413.24
FORMS: CMS-222

OMB NO: 0938-0146    EXPIRATION DATE: 09/30/2006
RESPS:110            HOURS:2,640          COSTS(000):$0
  State Medicaid Eligibility Quality Control Samplling Plan and
  Supporting Regulations in 42 CFR 431.800 - 431.865
FORMS: CMS-317

OMB NO: 0938-0147    EXPIRATION DATE: 09/30/2006
RESPS:12             HOURS:5,280          COSTS(000):$0
  State Medicaid Eligibility Control (MEQC) Sample Selection Lists
  and Supporting Regulations at 42 CFR 431.800 431.865
FORMS: CMS-319

OMB NO: 0938-0151    EXPIRATION DATE: 08/31/2008
RESPS:10,500         HOURS:5,250          COSTS(000):$0
  Laboratory Personnel Report (CLIA) and Supporting Regulations in
  42 CFR 493.1 - 493.2001
FORMS: CMS-209

OMB NO: 0938-0155    EXPIRATION DATE: 03/31/2007
RESPS:14             HOURS:476            COSTS(000):$0
  Municipal Health Services Cost Report Form and Supporting
  Regulations 42 CFR 405.2470
FORMS: CMS-255

OMB NO: 0938-0165    EXPIRATION DATE: 08/31/2006
RESPS:225            HOURS:7,860          COSTS(000):$0
  Prepaid Health Plan Cost Report
FORMS: CMS-276

OMB NO: 0938-0193    EXPIRATION DATE: 07/31/2007
RESPS:56             HOURS:560            COSTS(000):$0
  Transmittal and Notice of Approval of State Plan Material and
  Supporting Regulations in 42 CFR 430.10-430.20 and 440.167
FORMS: CMS-179

OMB NO: 0938-0202    EXPIRATION DATE: 07/31/2008
RESPS:1,231          HOURS:573,646        COSTS(000):$0
  Home Office Cost Statement and Supporting Regulations in 42 CFR
  413.17 and 413.20
FORMS: 287

OMB NO: 0938-0214    EXPIRATION DATE: 05/31/2009
RESPS:124,553,682    HOURS:1,611,303      COSTS(000):$0
  Medicare Secondary Payer Informaiton Collection and Supp. Regs.
  in 42 CFR 489.20, 411.25, 489.2
FORMS: 250-254

OMB NO: 0938-0236    EXPIRATION DATE: 06/30/2007
RESPS:3,592          HOURS:704,032        COSTS(000):$0
  Independent Renal Dialysis Facility Cost Report and Supporting
  Regulations 42 CFR 413.20 and 42 CFR 413.24
FORMS: CMS-265-94

OMB NO: 0938-0242    EXPIRATION DATE: 03/31/2007
RESPS:27,900         HOURS:2,325          COSTS(000):$0
  Fire Safety Survey Report Forms and Supporting Regulations in 42
  CFR 488.26 and 442.30
FORMS: CMS-2786M 2786R 2786S 2786T 2786U 2786V 2786W 2786X 2786Y

OMB NO: 0938-0245    EXPIRATION DATE: 09/30/2006
RESPS:10,000         HOURS:2,500          COSTS(000):$0
  Request for Enrollment in Supplementary Medical Insurance and
  Supporting Regulations in 42 CFR 407.10 & 407.11
FORMS: CMS-4040 CMS-4040-SP

OMB NO: 0938-0246    EXPIRATION DATE: 09/30/2006
RESPS:102            HOURS:22,515         COSTS(000):$0
  Certification of Medicaid Eligibilty Quality Control (MEQC)
  Payment Error Rates and Supporting Regulations at 42 CFR.431.800
  through 431.865
FORMS: CMS-301

OMB NO: 0938-0251    EXPIRATION DATE: 09/30/2007
RESPS:50,000         HOURS:12,500         COSTS(000):$0
  Application for Hospital Insurance and Supporting Regulations in
  42 CFR 406.7
FORMS: CMS-18F5

OMB NO: 0938-0266    EXPIRATION DATE: 02/29/2008
RESPS:4,312          HOURS:2,381          COSTS(000):$0
  Ambulatory Surgical Center (ASC) Health Insurance Benefits
  Agreement Form, Request for Certification, Survey Report and
  Supporting Regulations in 42 CFR 416.41, 416.43, 416.47, and...
FORMS: CMS-377 CMS-378 CMS-R-54 CMS-370

OMB NO: 0938-0267    EXPIRATION DATE: 06/30/2009
RESPS:630            HOURS:300,046        COSTS(000):$0
  Comprehensive Outpatient Rehabilitation Facility (CORF)
  Eligibility and Survey Forms and Information Collection
  Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64...
FORMS: 359 360 R-55

OMB NO: 0938-0269    EXPIRATION DATE: 02/28/2009
RESPS:822            HOURS:411            COSTS(000):$0
  Request for Accelerated Payments Supporting Regulations in 42
  CFR, section 412.116 & 413.64
FORMS: CMS-9042

OMB NO: 0938-0270    EXPIRATION DATE: 09/30/2007
RESPS:500            HOURS:1,000          COSTS(000):$0
  The Financial Statement of Debtor and Supporting Regulations in
  42 CFR, Section 405.376
FORMS: CMS-379

OMB NO: 0938-0272    EXPIRATION DATE: 12/31/2006
RESPS:277            HOURS:20,775         COSTS(000):$0
  Annual Report on Home and Community-Based Services Waivers and
  Supporting Regulations in 42 CFR 440.180 and 441.300-310
FORMS: CMS-372(S)

OMB NO: 0938-0273    EXPIRATION DATE: 12/31/2008
RESPS:2,960          HOURS:740            COSTS(000):$0
  Identification of Extension Units of Outpatient Physical
  Therapy/Outpatient Speech Pathology Providers and Support Regs.
FORMS: CMS-381

OMB NO: 0938-0279    EXPIRATION DATE: 11/30/2008
RESPS:174,461,278    HOURS:1,997,581      COSTS(000):$0
  Medicare Uniform Institutional Provider Bill
FORMS: CMS-1450

OMB NO: 0938-0287    EXPIRATION DATE: 12/31/2008
RESPS:27             HOURS:81             COSTS(000):$0
  Withholding Medicare Payments to Recover Medicaid Overpayments
  and Supporting Regulations in 42 CFR 447.31
FORMS: R-21

OMB NO: 0938-0296    EXPIRATION DATE: 04/30/2007
RESPS:125            HOURS:6,000          COSTS(000):$0
  Provider Reimbursement Manual, Part 1 - Chapter 27, Sections
  2721, 2722 and 2725, Request for Exception to End Stage Renal
  Disease Composite Rates and Supporting Regulations in 42 CFR..
FORMS: CMS-9044

OMB NO: 0938-0301    EXPIRATION DATE: 11/30/2008
RESPS:35,904         HOURS:603,306        COSTS(000):$0
  Medicare Provider Cost Report Reimbursement Questionnaire and
  Supporting Regulations in 42 CFR 413.20, 413.24, and 415.60
FORMS: CMS-339

OMB NO: 0938-0302    EXPIRATION DATE: 09/30/2006
RESPS:2,311          HOURS:10,821,923     COSTS(000):$0
  Information Collection Requirements in the Hospice Conditions
  for Coverage. The following regulations are affected: 42CFR
  418.22; 418.24; 418.28; 418.56(b),(e)(1),(e)(3); 418.58;......
FORMS: CMS-R-30

OMB NO: 0938-0313    EXPIRATION DATE: 08/31/2007
RESPS:2,286          HOURS:572            COSTS(000):$0
  Hospice Request for Certification in the Medicare Program and
  Supporting Regulations contained in 42 CFR Part 489.11 and 489.20
FORMS: CMS-417

OMB NO: 0938-0328    EXPIRATION DATE: 01/31/2008
RESPS:6,085          HOURS:5,511,544      COSTS(000):$0
  Hospital Conditions of Participation (COP) and Supporting
  Regulations in 42 CFR, Sections 482.12, 482.13, 482.21, 482.22,
  482.27, 482.30, 482.41, 482.43, 482.45, 482.53.....
FORMS: CMS-R-48

OMB NO: 0938-0334    EXPIRATION DATE: 01/31/2007
RESPS:3,305          HOURS:8,580          COSTS(000):$0
  Conditions for Coverage for Rural Health Clinics -- 42 CFR
  Section 491.9 and 491.10
FORMS: CMS-R-38

OMB NO: 0938-0338    EXPIRATION DATE: 07/31/2008
RESPS:602            HOURS:1,505          COSTS(000):$0
  Conditions of Participation for Portable X-ray Suppliers and
  Supporting Regulations in 42 CFR Sections 486.104, 486.106,
  486.110
FORMS: CMS-R-43

OMB NO: 0938-0345    EXPIRATION DATE: 06/30/2009
RESPS:212            HOURS:2,120          COSTS(000):$64
  Medicaid Statistical Information System
FORMS: CMS-R-284

OMB NO: 0938-0354    EXPIRATION DATE: 03/31/2009
RESPS:56             HOURS:1,568          COSTS(000):$15
  Annual Early and Periodic Screening, Diagnostic and Treatment
  Services (EPSDT) Participation Report
FORMS: 416

OMB NO: 0938-0355    EXPIRATION DATE: 11/30/2006
RESPS:24,150         HOURS:3,864          COSTS(000):$0
  Home Health Agency Survey and Deficiencies Report, Home Health
  Functional Assessment Instrument and Supporting Regulations in
  42 CFR 488.26 and 442.30
FORMS: CMS-1515 CMS-1572

OMB NO: 0938-0358    EXPIRATION DATE: 03/31/2007
RESPS:2,610          HOURS:652            COSTS(000):$0
  Psychiatric Unit Criteria Work Sheet, Rehabilitation Unit
  Criteria Work Sheet and Rehabilitation Hospital Criteria Work
  Sheet, and Supporting Regulations at 42 CFR 488.26
FORMS: 437 437A 437B

OMB NO: 0938-0359    EXPIRATION DATE: 03/31/2008
RESPS:397,500        HOURS:11,925         COSTS(000):$0
  Medical Records Review Under PPS and Supporting Regulations at
  42 CFR 412.40-412.52
FORMS: CMS-R-50

OMB NO: 0938-0360    EXPIRATION DATE: 01/31/2007
RESPS:1,320          HOURS:440            COSTS(000):$0
  End Stage Renal Disease Application and Survey and Certification
  Report Form and Supporting Regulations 42 CFR 488.60
FORMS: CMS-3427

OMB NO: 0938-0365    EXPIRATION DATE: 05/31/2007
RESPS:7,422          HOURS:854,891        COSTS(000):$0
  Home Health Medicare Conditions of Participation (CoP)
  Information Collection Requirements as outlined in Regulations
  -- 42 CFR 484.10, 484.12, 484.14, 484.16,....
FORMS: CMS-R-39

OMB NO: 0938-0372    EXPIRATION DATE: 01/31/2008
RESPS:7,400          HOURS:617            COSTS(000):$0
  ESRD Beneficiary Selection and Supporting Regulations Contained
  in 42 CFR 414.330
FORMS: CMS-382

OMB NO: 0938-0373    EXPIRATION DATE: 10/31/2007
RESPS:6,000          HOURS:1,500          COSTS(000):$0
  Medicare Participating Physician or Supplier Agreement
FORMS: CMS-460

OMB NO: 0938-0378    EXPIRATION DATE: 09/30/2007
RESPS:200            HOURS:100            COSTS(000):$0
  The Medicare/Medicaid Psychiatric Hospital Survey Data Contained
  in 42 CFR and Supporting Regulations in 42 CFR 482.60, 482.61,
  and 482.62
FORMS: CMS-724

OMB NO: 0938-0379    EXPIRATION DATE: 07/31/2009
RESPS:490            HOURS:1,225          COSTS(000):$0
  Hospice Survey and Deficiencies Report Form
FORMS: CMS-643

OMB NO: 0938-0386    EXPIRATION DATE: 10/31/2006
RESPS:4,297          HOURS:148,785        COSTS(000):$0
  Conditions for Coverage of Suppliers of End Stage Renal Disease
  (ESRD) Services and Supporting Regulations Contained in 42 CFR
  405.2100-.2171
FORMS: CMS-R-52

OMB NO: 0938-0391    EXPIRATION DATE: 03/31/2009
RESPS:60,000         HOURS:120,000        COSTS(000):$0
  Statement of Deficiencies and Plan of Correction
FORMS: CMS-2567

OMB NO: 0938-0426    EXPIRATION DATE: 08/31/2006
RESPS:3,729          HOURS:60,919         COSTS(000):$0
  Information Collection Requirements in HSQ-110, Acquisition,
  Protection and Disclosure of Peer Review Organization
  Information and Supporting Regulations in 42 CFR, Section
  480.104, 480.105,..
FORMS: CMS-R-70

OMB NO: 0938-0429    EXPIRATION DATE: 07/31/2007
RESPS:2              HOURS:20             COSTS(000):$0
  Imposition of Cost Sharing Charges Under Medicaid and Supporting
  Regulations contained in 42 CFR Section 447.53
FORMS: CMS-R-0053

OMB NO: 0938-0443    EXPIRATION DATE: 08/31/2006
RESPS:5,228          HOURS:2,822          COSTS(000):$0
  Information Collection Requirements in 42 CFR 478.18, 478.34,
  478.36, and 478.42, QIO Reconsiderations and Appeals
FORMS: CMS-R-72

OMB NO: 0938-0444    EXPIRATION DATE: 10/31/2008
RESPS:1,060          HOURS:22,684         COSTS(000):$0
  Information Collection Requirements in Final Peer Review
  Organizations Sanction Regulations 42 CFR Sections 1004.40,
  1004.50, 1004.50, 1004.60, 1004.70
FORMS: R-65

OMB NO: 0938-0445    EXPIRATION DATE: 06/30/2008
RESPS:6,036          HOURS:81,818         COSTS(000):$0
  QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR
  Sections 412.44, 412.46, 431.630, 476.71, 476.74, 476.78
FORMS: CMS-R-71

OMB NO: 0938-0447    EXPIRATION DATE: 01/31/2007
RESPS:4,360          HOURS:34,880         COSTS(000):$0
  End Stage Renal Disease Medical Information System ESRD Facility
  Survey and Supporting Regulations in 42 CFR 405.2133
FORMS: CMS-2744

OMB NO: 0938-0448    EXPIRATION DATE: 01/31/2007
RESPS:69,760         HOURS:34,880         COSTS(000):$0
  End Stage Renal Disease Death Notification, P.L. 95-292; 42 CFR
  405.;2133; 45 CFR 5,5b; 20 CFR Parts 401, 422E
FORMS: CMS-2746

OMB NO: 0938-0449    EXPIRATION DATE: 09/30/2008
RESPS:132            HOURS:7,930          COSTS(000):$0
  Home & Community Based Waiver Requests and Supporting
  Regulations; 42 CFR 440.180, 441.300-.310
FORMS: CMS-8003

OMB NO: 0938-0454    EXPIRATION DATE: 08/31/2006
RESPS:689,572        HOURS:441,793        COSTS(000):$0
  Physician Certifications/Recertifications in Skilled Nursing
  Facilities (SNFs) Manual Instructions and Supporting Regulation
  in 42 CFR 424.20
FORMS: CMS-R-5

OMB NO: 0938-0456    EXPIRATION DATE: 11/30/2006
RESPS:1,225          HOURS:2,450          COSTS(000):$0
  Indirect Medical Education (IME) and Supporting Regulations 42
  CFR 412.105
FORMS: CMS-R-64

OMB NO: 0938-0463    EXPIRATION DATE: 04/30/2007
RESPS:13,000         HOURS:2,480,000      COSTS(000):$0
  Skilled Nursing Facility and Silled Nursing Facility Cost Report
  and Supporting Regulations in 42 CFR 413.20, 413.24, and 413.106
FORMS: CMS-2540-96

OMB NO: 0938-0467    EXPIRATION DATE: 03/31/2009
RESPS:54             HOURS:124,054        COSTS(000):$0
  Income and Eligibility Verification System Reporting and
  Supporting Regs.
FORMS: R-0074

OMB NO: 0938-0469    EXPIRATION DATE: 09/30/2008
RESPS:370            HOURS:62             COSTS(000):$0
  The Fiscal Soundness Reporting Requirements
FORMS: CMS-906

OMB NO: 0938-0470    EXPIRATION DATE: 04/30/2007
RESPS:55             HOURS:5,958          COSTS(000):$0
  Qualification Application; Medicare+Choice Application of HMOs,
  PPOs, & State Licensed PSOs; Medicare+Choice Application for
  Federally Waived PSOs; Medicare+Choice Application for Medicare..
FORMS: CMS-901A 901B 901C

OMB NO: 0938-0477    EXPIRATION DATE: 09/30/2008
RESPS:40             HOURS:160            COSTS(000):$0
  Payment Adjustment for Sole Community Hospitals and Supporting
  Regs. in 42 CFR 412.92
FORMS: CMS-R-79

OMB NO: 0938-0484    EXPIRATION DATE: 09/30/2006
RESPS:1,100          HOURS:275            COSTS(000):$0
  Emergency and Foreign Hospital Services - Beneficiary Statement
  in Canadian Travel Claims and Supporting Regulations in 42 CFR,
  Section 424.123
FORMS: CMS-R-96

OMB NO: 0938-0501    EXPIRATION DATE: 04/30/2007
RESPS:4,300          HOURS:717            COSTS(000):$0
  Medicare Qualification Statement for Federal Employees and
  Supporting Regulations in 42 CFR 406.15
FORMS: CMS-565

OMB NO: 0938-0502    EXPIRATION DATE: 03/31/2009
RESPS:2,700,000      HOURS:472,259        COSTS(000):$0
  Medicaid - Determining Third Party Liability (TPL) State Plan
  Preprint and Supporting Regulation in 42 CFR 433.138
FORMS: CMS-R-0107

OMB NO: 0938-0512    EXPIRATION DATE: 12/31/2006
RESPS:58             HOURS:116            COSTS(000):$0
  Organ Procurement Organization's Health Insurance Benefits
  Agreement and Supporting Regulations 42 CFR 486.301-486.348
FORMS: CMS-576A

OMB NO: 0938-0526    EXPIRATION DATE: 06/30/2007
RESPS:53             HOURS:1              COSTS(000):$0
  Quality Improvement (formerly Peer Review) Organization
  Contracts: Solicitation of Statement of Interest from In-State
  Organizations, General Notice and Supporting...
FORMS: CMS-R-118

OMB NO: 0938-0534    EXPIRATION DATE: 09/30/2008
RESPS:1,200,000      HOURS:240,000        COSTS(000):$0
  Attending Physician's Certification of Medical Necessity for
  Home Oxygen Therapy and Supporting Regulations 42 CFR 410.38 and
  42 CFR 424.5
FORMS: CMS-484

OMB NO: 0938-0544    EXPIRATION DATE: 03/31/2009
RESPS:12,500         HOURS:6,250          COSTS(000):$0
  Survey Report Form Clinical Laboratory Improvement Amendments
  (CLIA) and supporting regulations in 42 CFR 493.1-493.2001
FORMS: CMS-1557

OMB NO: 0938-0564    EXPIRATION DATE: 11/30/2006
RESPS:13,311         HOURS:1              COSTS(000):$0
  Proper Claim Not Filed and Supporting Regulation Contained in 42
  CFR 411.32(c)
FORMS: CMS-R-136

OMB NO: 0938-0565    EXPIRATION DATE: 12/31/2008
RESPS:341,065        HOURS:1,986,810      COSTS(000):$0
  IRS/SSA/CMS Data Match and Supporting Regulations in 42 CFR
  Sections 411.20-411.206
FORMS: CMS-R-137

OMB NO: 0938-0566    EXPIRATION DATE: 05/31/2007
RESPS:21,171,480     HOURS:1,764,290      COSTS(000):$0
  Advance Beneficiary Notice and Supporting Regulations in 42 CFR
  411.404, 411.406, and 411.408
FORMS: CMS-R-131

OMB NO: 0938-0568    EXPIRATION DATE: 03/31/2007
RESPS:49,500         HOURS:50,325         COSTS(000):$0
  Medicare Current Beneficiary Survey (MCBS): Rounds 38-46
FORMS: CMS-P-0015A

OMB NO: 0938-0573    EXPIRATION DATE: 11/30/2008
RESPS:500            HOURS:500            COSTS(000):$0
  Medicare Geographic Classification Review Board Procedures and
  Criteria and Supporting Regulations in 42 CFR, Section 412.256
FORMS: R-138

OMB NO: 0938-0575    EXPIRATION DATE: 08/31/2006
RESPS:50             HOURS:150            COSTS(000):$0
  Analysis of Malpractice Premium Data
FORMS: CMS-R-143

OMB NO: 0938-0578    EXPIRATION DATE: 07/31/2007
RESPS:2,280          HOURS:54,780         COSTS(000):$0
  Medicaid Drug Rebate Program - Manufacturers and Supporting
  Regulation at 42 CFR 447.534
FORMS: CMS-367 367A 367C

OMB NO: 0938-0579    EXPIRATION DATE: 08/31/2006
RESPS:20             HOURS:455            COSTS(000):$0
  Business Proposal Formats for Quality Improvement Organizations
  (QIOs) - previously known as PEER REVIEW ORGANIZATIONS (PROs)
FORMS: CMS-FORM-718BP 719BP 720BP 721BP SUM STAFFING SC1 SC2

OMB NO: 0938-0581    EXPIRATION DATE: 09/30/2007
RESPS:16,000         HOURS:20,000         COSTS(000):$0
  Clinical Laboratory Improvement Amendments Application Form 42
  CFR 493.1-.2001
FORMS: CMS-116

OMB NO: 0938-0582    EXPIRATION DATE: 07/31/2009
RESPS:204            HOURS:9,389          COSTS(000):$0
  State Drug Rebate (Medicaid)
FORMS: CMS-368 CMS-R-144

OMB NO: 0938-0599    EXPIRATION DATE: 11/30/2007
RESPS:50             HOURS:4,500          COSTS(000):$0
  CLIA Budget Workload Reports and Supporting Regulations
  Contained in 42 CFR 493.1-.2001
FORMS: CMS-102 CMS-105

OMB NO: 0938-0600    EXPIRATION DATE: 12/31/2008
RESPS:193,200        HOURS:579,600        COSTS(000):$0
  Medicare Credit Balance Reporting Requirements and Supporting
  Regulations in 42 CFR 405.371, 405.378, and 413.20
FORMS: CMS-838

OMB NO: 0938-0610    EXPIRATION DATE: 10/31/2008
RESPS:33,096         HOURS:924,120        COSTS(000):$0
  Advanced Directives (Medicare and Medicard) - BDP-718
FORMS: CMS-R-10

OMB NO: 0938-0612    EXPIRATION DATE: 06/30/2007
RESPS:111,354,920    HOURS:9,823,934      COSTS(000):$0
  Information Collection Requirements (ICR) Contained in the
  Clinical Laboratory Improvement Amendments (CLIA) Regulations 42
  CFR Part 493.801, 493.803, 493.1232, 493.1233, 493.1234,...
FORMS: CMS-R-26

OMB NO: 0938-0618    EXPIRATION DATE: 04/30/2008
RESPS:40             HOURS:3,200          COSTS(000):$0
  Limitations on Provider Related Donations and Health Care
  Related Taxes, etc.
FORMS: R-148

OMB NO: 0938-0626    EXPIRATION DATE: 09/30/2006
RESPS:10,000         HOURS:1,250          COSTS(000):$0
  Authorization Agreement for Electronic Funds Transfer
FORMS: CMS-588

OMB NO: 0938-0653    EXPIRATION DATE: 09/30/2006
RESPS:11,250         HOURS:2,813          COSTS(000):$0
  Post Laboratory Survey Questionnaire--Laboratory, and Supporting
  Regulations in 42 CFR 493.1771, 493.1773, and 493.1777
FORMS: CMS-668B

OMB NO: 0938-0657    EXPIRATION DATE: 09/30/2006
RESPS:36             HOURS:108            COSTS(000):$0
  End-Stage Renal Disease (ESRD) Network Semi-Annual Cost Report
  Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR
  405.2112
FORMS: CMS-685

OMB NO: 0938-0658    EXPIRATION DATE: 09/30/2006
RESPS:36             HOURS:1,080          COSTS(000):$0
  End-Stage Renal Disease (ESRD) Network Business Proposal Forms
  and Supporting Regulations in 42 CFR 405.2110 and 42 CFR 405.2112
FORMS: CMS-684A-684I

OMB NO: 0938-0667    EXPIRATION DATE: 01/31/2007
RESPS:5,600          HOURS:1              COSTS(000):$0
  Examination and Treatment for Emergency Medical Conditions and
  Women in Labor (EMTALA), 42 CFR 482.12, 488.18, 489.20, and
  489.24, & HCFA-1005-IFC, PPS for Hospital Outpatient Services,...
FORMS: CMS-R-142

OMB NO: 0938-0676    EXPIRATION DATE: 03/31/2007
RESPS:3,744          HOURS:139,560        COSTS(000):$350
  Reconciliation of State Invoice and Prior Quarter Adjustment
  Statement
FORMS: CMS-304 304A

OMB NO: 0938-0679    EXPIRATION DATE: 09/30/2008
RESPS:5,400,000      HOURS:1,080,000      COSTS(000):$0
  Durable Medical Equipment Regional Carrier, Certificates of
  Medical Necessity
FORMS: 846-849 854 10125 10126

OMB NO: 0938-0685    EXPIRATION DATE: 04/30/2009
RESPS:400,000        HOURS:1,000,000      COSTS(000):$0
  Medicare Enrollment Application
FORMS: CMS-855A 855B 855I 855R 855S

OMB NO: 0938-0686    EXPIRATION DATE: 05/31/2008
RESPS:76             HOURS:768            COSTS(000):$0
  Granting and Withedrawal of Deeming Authority to Private
  Nonprofit Accreditation Organizations and of State Exemption
  Under State Laboratory Programs and Supporting Regs
FORMS: R-185

OMB NO: 0938-0688    EXPIRATION DATE: 02/28/2007
RESPS:59             HOURS:118            COSTS(000):$0
  Conditions of Coverage for Organ Procurement Organizations
  (OPOs) and Supporting Regulations in 42 CFR, Section 486.304,
  486.306, 486.307, 486.310, 486.316, 486.218, and 486.325
FORMS: CMS-R-13

OMB NO: 0938-0691    EXPIRATION DATE: 08/31/2006
RESPS:100            HOURS:100            COSTS(000):$0
  Medicare Disproportionate Share Adjustment Procedures and
  Criteria and Supporting Regulations in 42 CFR 412.106
FORMS: CMS-R-194

OMB NO: 0938-0692    EXPIRATION DATE: 03/31/2009
RESPS:12,500,000     HOURS:208,333        COSTS(000):$0
  Important Message From Medicare
FORMS: CMS-R-193

OMB NO: 0938-0697    EXPIRATION DATE: 01/31/2007
RESPS:57             HOURS:342            COSTS(000):$0
  Medicaid Report on Payables and Receivables
FORMS: CMS-R199

OMB NO: 0938-0701    EXPIRATION DATE: 01/31/2007
RESPS:1,569          HOURS:429,598        COSTS(000):$0
  Health Plan Employer Data and Information Set (HEDIS) and Health
  Outcome Survey (HOS) and Supporting Regulations at 42 CFR 422.152
FORMS: CMS-R-200

OMB NO: 0938-0702    EXPIRATION DATE: 08/31/2006
RESPS:43,501,897     HOURS:531,149        COSTS(000):$0
  Information Collection Requirements Referenced in HIPAA, Title
  1, for the Group Market, Supporting Regulations at 45 CFR
  146.111, 146.115, 146.117, 146.150, 146.152, 146.160, and
  146.180, and...
FORMS: CMS-R-206

OMB NO: 0938-0703    EXPIRATION DATE: 08/31/2006
RESPS:3,242,500      HOURS:914,347        COSTS(000):$0
  Information Collection Requirements Referenced in HIPAA, Title 1
  for the Individual Market, Supporting Regulations at 45 CFR
  148.120, 148.122, 148.124, 148.126, and 148.128, and Forms/....
FORMS: CMS-R-205

OMB NO: 0938-0707    EXPIRATION DATE: 05/31/2008
RESPS:40             HOURS:3,200          COSTS(000):$0
  Model Application Template for State Child Health Plan Under
  Title XXI of the Social Security Act, State Children's Health
  Insurance Program, & Model Application Template & Instructions
FORMS: CMS-R-211

OMB NO: 0938-0709    EXPIRATION DATE: 02/28/2007
RESPS:15,000         HOURS:3,000          COSTS(000):$0
  Data Collection for the Second Generation Social Health
  Maintenance Organization Demonstration
FORMS: CMS-R-204

OMB NO: 0938-0714    EXPIRATION DATE: 11/30/2007
RESPS:200            HOURS:2,000          COSTS(000):$400
  Procedures for advisory opinions concerning physician referrals
  and supporting regulations in 42 CFR Sections 411.370 through
  411.389
FORMS: CMS-R-216

OMB NO: 0938-0717    EXPIRATION DATE: 11/30/2007
RESPS:35,000         HOURS:280,000        COSTS(000):$0
  Information Collection Requirements Referenced in 42 CFR Sec.
  424.57; Additional DMEPOS Supplier Standards
FORMS: CMS-R-215

OMB NO: 0938-0721    EXPIRATION DATE: 08/31/2007
RESPS:500            HOURS:42             COSTS(000):$0
  Independent Diagnostic Testing Facility and Supporting
  Regulations Contained in 42 CFR 410.33
FORMS: CMS-R-214

OMB NO: 0938-0723    EXPIRATION DATE: 02/28/2009
RESPS:11             HOURS:2,200          COSTS(000):$0
  Medicare Integrity Program Organizational Conflict of Interest
  Disclosure Certificate and Supporting Regs at 42 CFR 421.300-
  421.316
FORMS: CMS-R-232

OMB NO: 0938-0730    EXPIRATION DATE: 04/30/2007
RESPS:26,820         HOURS:7,197          COSTS(000):$0
  Subpart D-Private Contracts and Supporting Regulations in 42 CFR
  405.410, 405.430, 405.435, 405.440, 405.445, 405.455, 410.61,
  415.110, and 424.24
FORMS: R-234

OMB NO: 0938-0731    EXPIRATION DATE: 06/30/2008
RESPS:448            HOURS:7,840          COSTS(000):$0
  Quarterly Children's Health Insurance Program Statement of
  Expenditures for Title XXI
FORMS: CMS-21

OMB NO: 0938-0732    EXPIRATION DATE: 04/30/2007
RESPS:168,000        HOURS:55,450         COSTS(000):$0
  The Medicare Managed Care CAHPS Survey and Supporting
  Regulations in 42 CFR 417.126 and 417.470
FORMS: CMS-R-246

OMB NO: 0938-0734    EXPIRATION DATE: 09/30/2007
RESPS:1,500          HOURS:750            COSTS(000):$0
  Data Use Agreement Information Collection Requirements, Model
  Language, and Supporting Regulations in 45 CFR Section 5b
FORMS: CMS-R-235

OMB NO: 0938-0738    EXPIRATION DATE: 12/31/2008
RESPS:5,700          HOURS:1,425          COSTS(000):$0
  National Medical & You Education Program (NMEP) Survey of
  Medicare Beneficiaries
FORMS: CMS-R-254

OMB NO: 0938-0739    EXPIRATION DATE: 05/31/2009
RESPS:4,719,118      HOURS:3,284,247      COSTS(000):$0
  SNF Resident Assessment MDS Data and Supporting Regulations at
  42 CFR 413.337, 413.343 and 424.32, and 483.20
FORMS: R-250

OMB NO: 0938-0741    EXPIRATION DATE: 12/31/2008
RESPS:50,000         HOURS:3,300          COSTS(000):$0
  Medicare Advantage Disenrollment Form to Original Medicare
FORMS: R-257

OMB NO: 0938-0746    EXPIRATION DATE: 08/31/2008
RESPS:52             HOURS:1,976          COSTS(000):$0
  Medicaid Disproportionate Share Hospital Annual Reporting
FORMS: R-266

OMB NO: 0938-0749    EXPIRATION DATE: 11/30/2007
RESPS:20,000         HOURS:10,000         COSTS(000):$0
  On-Site Inspection for Durable Medical Equipment (DME) Supplier
  Location and Supporting Regulations in 42 CFR, Section 424.57
FORMS: CMS-R-263

OMB NO: 0938-0753    EXPIRATION DATE: 07/31/2008
RESPS:13,121,407     HOURS:2,064,439      COSTS(000):$0
  Medicare Plus Choice Program Requirements Referenced in 42 CFR
  422.000 - 422.700
FORMS: CMS-R-267

OMB NO: 0938-0754    EXPIRATION DATE: 05/31/2008
RESPS:80,000         HOURS:1              COSTS(000):$0
  Inpatient Psychiatric Services for Individuals Under Age 21 and
  Supporting Regs.
FORMS: R-238

OMB NO: 0938-0756    EXPIRATION DATE: 03/31/2008
RESPS:7,000          HOURS:583            COSTS(000):$0
  MSInteractive Survey Tool for www.medicare.gov
FORMS: CMS-R-268

OMB NO: 0938-0758    EXPIRATION DATE: 01/31/2008
RESPS:1,720          HOURS:302,720        COSTS(000):$0
  Hospice Cost Report and Supporting Regulations in 42 CFR 413.20
  and 413.24
FORMS: CMS-R-249

OMB NO: 0938-0760    EXPIRATION DATE: 08/31/2006
RESPS:10,156,569     HOURS:8,556,995      COSTS(000):$0
  Medicare and Medicaid Programs OASIS Collection Requirements as
  Part of the CoPs for HHAs and Supp. Regs. in 42 CFR 484.55,
  484.205, 484.245, 484.250
FORMS: R-245

OMB NO: 0938-0761    EXPIRATION DATE: 06/30/2009
RESPS:102,203        HOURS:1,374,051      COSTS(000):$20
  Medicare and Medicaid Programs: Use and Reporting of OASIS Data
  as Part of the CoPs for HHAs and Supporting Regulations in 42
  CFR 484.11 and 484.20
FORMS: R-209

OMB NO: 0938-0763    EXPIRATION DATE: 08/31/2006
RESPS:5,807          HOURS:13,272         COSTS(000):$0
  The Plan Benefit Package (PBP) and Formulary Submission for
  Medicare Advantage (MA) Plans and Prescription Drug Plans (PDPs)
FORMS: CMS-R-262

OMB NO: 0938-0769    EXPIRATION DATE: 03/31/2009
RESPS:1,500          HOURS:375            COSTS(000):$0
  Request for Retirement Benefit Informatin (BBA '97)
FORMS: CMS-R-285

OMB NO: 0938-0770    EXPIRATION DATE: 09/30/2008
RESPS:4,731          HOURS:20,372         COSTS(000):$0
  Community Mental Health Center Site Visit Assessment Tool and
  Supporting Regulations in 42 CFR 410.2
FORMS: CMS-R-273

OMB NO: 0938-0776    EXPIRATION DATE: 09/30/2007
RESPS:200            HOURS:8,000          COSTS(000):$0
  Medicare Program: Process for Making National Coverage
  Determinations
FORMS: CMS-R-0290

OMB NO: 0938-0777    EXPIRATION DATE: 08/31/2006
RESPS:17,996         HOURS:2,999          COSTS(000):$0
  Medicare Lifestyle Modification Program Demonstration and
  Addendum
FORMS: CMS-R-289

OMB NO: 0938-0778    EXPIRATION DATE: 01/31/2007
RESPS:616            HOURS:438            COSTS(000):$0
  Medicare + Choice Organization Appeals and Grievance Data
  Collection and Reporting Requirements. Data Disclosure
  Requirements 422.111 and 422.564
FORMS: CMS-R-0282

OMB NO: 0938-0779    EXPIRATION DATE: 09/30/2008
RESPS:44,200         HOURS:18,564         COSTS(000):$0
  Medicare CAHPS Disenrollment Surveys and Supporting Regs. in 42
  CFR 417.126, 417.470, 422.64, and 422.210
FORMS: CMS-R-295

OMB NO: 0938-0781    EXPIRATION DATE: 08/31/2006
RESPS:31,000         HOURS:3,100          COSTS(000):$0
  Home Health Advance Beneficiary Notices and Supporting
  Regulations in 42 CFR, Section 411.404 and 484.10(a) and (e)
FORMS: CMS-R-296

OMB NO: 0938-0786    EXPIRATION DATE: 06/30/2009
RESPS:14,226         HOURS:648,877        COSTS(000):$0
  External Quality Review of Medicaid MCOs and Supporting
  Regulations in 42 CFR 438.360, 438.362, and 438.364
FORMS: CMS-R-0305

OMB NO: 0938-0787    EXPIRATION DATE: 09/30/2007
RESPS:5,000          HOURS:1,250          COSTS(000):$0
  Request for Employment Information
FORMS: CMS-R-297

OMB NO: 0938-0790    EXPIRATION DATE: 02/28/2009
RESPS:54             HOURS:44,378         COSTS(000):$0
  Medicare and Medicaid; Programs For All-Inclusive Care For The
  Elderly (PACE) Contained in 42 CFR 460.12-460.210
FORMS: R-244

OMB NO: 0938-0791    EXPIRATION DATE: 05/31/2007
RESPS:116,038        HOURS:16,960         COSTS(000):$0
  A Project to Develop an Outcome-ased Continuous Quality
  Improvement System and Core Outcome and Comprehensive Assessment
  Data Set for PACE
FORMS: CMS-R-299

OMB NO: 0938-0792    EXPIRATION DATE: 01/31/2007
RESPS:3,528          HOURS:3,435          COSTS(000):$0
  Refinement of RHC Certification and QAPI and Supporting
  Regulations in 42 CFR 491.8 and 491.11
FORMS: CMS-R-0242

OMB NO: 0938-0795    EXPIRATION DATE: 09/30/2007
RESPS:37             HOURS:11,100         COSTS(000):$0
  Conflict of Interest and Ownership and Control Informaiton
FORMS: CMS-R-312

OMB NO: 0938-0796    EXPIRATION DATE: 04/30/2007
RESPS:142,920        HOURS:47,640         COSTS(000):$0
  Medicare Consumer Assessment of Health Plan Survey-Fee For
  Service (CAHPS-FFS)
FORMS: CMS-10000

OMB NO: 0938-0798    EXPIRATION DATE: 11/30/2006
RESPS:2,272          HOURS:41,063         COSTS(000):$0
  Prospective Payments for Hospital Outpatient Services and
  Supporting Regulations in 42 CFR 413.24, 413.65, and 419.42
FORMS: CMS-R-240

OMB NO: 0938-0802    EXPIRATION DATE: 06/30/2008
RESPS:58             HOURS:203            COSTS(000):$0
  Eligibility of Drugs, Biologicals and Radio-pharmaceuticals for
  Pass-Through Provisions Under the OPPS Supporting Regulations in
  42 CFR Part 419.43
FORMS: 10008

OMB NO: 0938-0806    EXPIRATION DATE: 07/31/2008
RESPS:7,094          HOURS:12,379         COSTS(000):$0
  Informatics, Telemedicine, and Education Demonstration Project
FORMS: CMS-10014

OMB NO: 0938-0812    EXPIRATION DATE: 11/30/2006
RESPS:2,000          HOURS:500            COSTS(000):$0
  Employee Building Pass Application and File
FORMS: CMS-730 CMS-80

OMB NO: 0938-0818    EXPIRATION DATE: 01/31/2007
RESPS:6,832          HOURS:75,294         COSTS(000):$0
  Expanded Coverage for Diabetes Outpatient Self-Management
  Training Services and Supporting Regulations Contained in 42 CFR
  410.141, 410.142, 410.143, 410.144, 410.145, 410.146....
FORMS: R-247

OMB NO: 0938-0819    EXPIRATION DATE: 04/30/2009
RESPS:2,600          HOURS:100            COSTS(000):$0
  HIPAA Nondiscrimination Provisions (Regulation HCFA-2078-P)
FORMS: CMS-10009

OMB NO: 0938-0827    EXPIRATION DATE: 04/30/2009
RESPS:18             HOURS:194            COSTS(000):$0
  HIPAA Nondiscrimination Provisions (Regulation HCFA-2022-IFC)
FORMS: CMS-10001

OMB NO: 0938-0829    EXPIRATION DATE: 05/31/2007
RESPS:71,200         HOURS:7,120          COSTS(000):$0
  Medicare+Choice Appeal Notices, "Notice of Denial of Medical
  Coverage", "Notice of Denial of Payment" and supporting
  regulations in 42 CFR 422.568
FORMS: CMS-10003

OMB NO: 0938-0832    EXPIRATION DATE: 09/30/2007
RESPS:3,300          HOURS:275            COSTS(000):$0
  Health Insurance Benefit Agreement and Supporting Regulations at
  42 CFR Part 489 and 491
FORMS: CMS-1561 CMS-1561A

OMB NO: 0938-0833    EXPIRATION DATE: 05/31/2008
RESPS:1,199,000      HOURS:713,250        COSTS(000):$0
  Restraint and Seclusion Standards for Psychiatric Residential
  Treatment Facilities
FORMS: CMS-R-306

OMB NO: 0938-0841    EXPIRATION DATE: 08/31/2007
RESPS:1,114,124      HOURS:864,973        COSTS(000):$0
  State Children's Health Insurance Program and Supporting
  Regulations in 42 CFR 431.636, 457.50, 457.60, 457.70, 457.340,
  457.350, 457.431, 457.440, 457.525, 457.560,...
FORMS: CMS-R-308

OMB NO: 0938-0842    EXPIRATION DATE: 03/31/2009
RESPS:390,000        HOURS:421,939        COSTS(000):$0
  Inpatient Rehabilitation Assessment Instrument and Data Set for
  PPS for Inpatient Rehabilitation Facilities
FORMS: 10036

OMB NO: 0938-0846    EXPIRATION DATE: 11/30/2007
RESPS:62,824         HOURS:422,008        COSTS(000):$0
  Physicians' Referrals to Health Care Entitles With Which They
  Have Financial Relationships and Supporting Regulations in 42
  CFR, Sections 411.352 through 411.361
FORMS: CMS-10047

OMB NO: 0938-0850    EXPIRATION DATE: 02/28/2007
RESPS:1,000,000      HOURS:116,747        COSTS(000):$0
  State Health Insurance Assistance Program (SHIP) Client Contact
  Form, Public and Media Activity Form, and Resource Report
FORMS: CMS-10028A B C

OMB NO: 0938-0857    EXPIRATION DATE: 01/31/2008
RESPS:12             HOURS:192            COSTS(000):$0
  Recognition of pass-through payment for additional (new)
  categories of devices under the Outpatient Prospective Payment
  System and Supporting Regulations in 42 CFR, Part 419
FORMS: CMS-10052

OMB NO: 0938-0860    EXPIRATION DATE: 03/31/2008
RESPS:15             HOURS:180            COSTS(000):$0
  Recognition of Payment for New Technology Services for
  Ambulatory Payment Classifications (APCs) under the Outpatient
  Propsective Payment System and Supporting....
FORMS: CMS-10054

OMB NO: 0938-0866    EXPIRATION DATE: 02/29/2008
RESPS:3,400,000      HOURS:1              COSTS(000):$0
  ICRs Contained in 45 CFR Part 162; HIPAA Standards for
  Electronic Transactions
FORMS: CMS-R-218

OMB NO: 0938-0869    EXPIRATION DATE: 08/31/2006
RESPS:3,600          HOURS:1,080          COSTS(000):$0
  Survey of Newly Eligible Medicare Beneficiaries
FORMS: CMS-10050

OMB NO: 0938-0871    EXPIRATION DATE: 04/30/2009
RESPS:1,680          HOURS:1,106          COSTS(000):$0
  Medicare Lifestyle Modification Program Demonstration
FORMS: CMS-10044

OMB NO: 0938-0872    EXPIRATION DATE: 11/30/2008
RESPS:92,789         HOURS:51,314         COSTS(000):$100
  Minimum Data Set (MDS) For Swing Bed Hospitals and Supporting
  Regulations in 42 CFR 483.20 and 413.337
FORMS: 10064

OMB NO: 0938-0873    EXPIRATION DATE: 09/30/2008
RESPS:250            HOURS:620            COSTS(000):$0
  Quality Assessment and Performance Improvement (QAPI) Project
  Completion Report 42 CFR 422.152
FORMS: CMS-10060

OMB NO: 0938-0874    EXPIRATION DATE: 10/31/2008
RESPS:2,550,000      HOURS:1              COSTS(000):$0
  HIPAA Standard Unique Employer Identifier and Supporting
  Regulations in 45 CFR Part 160 and 162
FORMS: CMS-R-220

OMB NO: 0938-0878    EXPIRATION DATE: 04/30/2009
RESPS:14,091,370     HOURS:8,351          COSTS(000):$0
  Collection of Diagnostic Data from Medicare Advantage
  Organizations for Risk Adjusted Payments Supporting Reg 42 CFR
  Part 422 & 423 Subparts F and G
FORMS: CMS-10062

OMB NO: 0938-0880    EXPIRATION DATE: 08/31/2006
RESPS:800            HOURS:133            COSTS(000):$0
  Medicare Waiver Demonstration Application
FORMS: CMS-10069

OMB NO: 0938-0887    EXPIRATION DATE: 10/31/2006
RESPS:20             HOURS:840            COSTS(000):$0
  Matching Gants to States for the Operation of High Risk Pools
  and Supporting Regulations at 42 CFR 148.316, 148.318, and
  148.320
FORMS: CMS-10078

OMB NO: 0938-0889    EXPIRATION DATE: 09/30/2006
RESPS:25             HOURS:115            COSTS(000):$0
  Pharmacy Plus Template Application
FORMS: CMS-10067

OMB NO: 0938-0890    EXPIRATION DATE: 03/31/2007
RESPS:4,500          HOURS:1,078          COSTS(000):$0
  Design and Implementation of a Targeted Beneficiary Survey on
  Access to Physician Services Among Medicare Beneficiaries
FORMS: CMS-10084

OMB NO: 0938-0892    EXPIRATION DATE: 08/31/2006
RESPS:3,000          HOURS:850            COSTS(000):$0
  Publications Use Study
FORMS: CMS-10080

OMB NO: 0938-0893    EXPIRATION DATE: 09/30/2006
RESPS:928            HOURS:253            COSTS(000):$0
  Data Collection for Administering the Survey for the Evaluation
  of the Demonstration to Maintain Independence and Employment
  (DMIE)
FORMS: CMS-10081

OMB NO: 0938-0894    EXPIRATION DATE: 03/31/2008
RESPS:5,089          HOURS:509            COSTS(000):$0
  Assessing the Division of Beneficiary Inquiry Service's
  Performance for Written Responses
FORMS: CMS-10068

OMB NO: 0938-0897    EXPIRATION DATE: 10/31/2006
RESPS:194            HOURS:49             COSTS(000):$0
  Election to be paid 100% of PPS rates rather than 5-year
  phase-in and Notification of FIs and CMS of co-located Medicare
  providers and Supporting Regulations in 42 CFR, Sections 412.22
  and 412.533
FORMS: CMS-10088

OMB NO: 0938-0898    EXPIRATION DATE: 11/30/2007
RESPS:51             HOURS:2,360          COSTS(000):$41
  CMSO Survey of States: Performance Measurement Reporting
  Capability
FORMS: CMS-10082

OMB NO: 0938-0900    EXPIRATION DATE: 09/30/2007
RESPS:7,000          HOURS:583            COSTS(000):$0
  MSInteractive Survey Tool for cms.hhs.gov website
FORMS: CMS-10072

OMB NO: 0938-0902    EXPIRATION DATE: 09/30/2006
RESPS:2,200          HOURS:550            COSTS(000):$0
  Evaluation of the Illinois and Wisconsin State Pharmacy
  Assistance Waivers
FORMS: CMS-10087

OMB NO: 0938-0903    EXPIRATION DATE: 02/28/2007
RESPS:48             HOURS:960            COSTS(000):$0
  CMS/AoA Aging and Disability Resource Center Grant Program (Real
  Choice Systems Change Grants for Community Living and the Older
  Americans Act, Public Law 106-501 (Catalog of Federal Domestic...
FORMS: CMS-10093

OMB NO: 0938-0905    EXPIRATION DATE: 03/31/2007
RESPS:10,980         HOURS:915            COSTS(000):$0
  Accepting New Patients Indicator UPIN (Unique Physician
  Identifi- cation Number) Participating Physicians Directory
FORMS: CMS-10091

OMB NO: 0938-0906    EXPIRATION DATE: 02/28/2007
RESPS:11,310         HOURS:1,087          COSTS(000):$0
  Evaluation of the Medicaid Health Reform Demonstrations
FORMS: CMS-10094

OMB NO: 0938-0907    EXPIRATION DATE: 05/31/2009
RESPS:3,800          HOURS:1,216,000      COSTS(000):$0
  Hospital Wage Index Occupational Mix Survey and Supporting
  Regulations in 42 CFR Sections 412.230, 412.304 and 413.65
FORMS: 10079

OMB NO: 0938-0910    EXPIRATION DATE: 03/31/2007
RESPS:612,000        HOURS:68,000         COSTS(000):$0
  "Detailed Explanation of Non-Coverage" and "Important Medicare
  Message of Non-Coverage" and Supporting Regulations in 42 CFR
  422.620, 422.624, and 422.626
FORMS: CMS-10095

OMB NO: 0938-0911    EXPIRATION DATE: 03/31/2007
RESPS:1,040          HOURS:4,160          COSTS(000):$0
  Review of National Coverage Determinations and Local Coverage
  Determinations and Supporting Regulations in 42 CFR, Sections
  426.400 and 426.500
FORMS: CMS-10099

OMB NO: 0938-0912    EXPIRATION DATE: 02/28/2007
RESPS:40,000         HOURS:6,667          COSTS(000):$0
  Medicare Health Survey (MHS)
FORMS: CMS-10096

OMB NO: 0938-0915    EXPIRATION DATE: 06/30/2009
RESPS:20,514         HOURS:6,923          COSTS(000):$0
  Medicare Contractor Provider Satisfaction Survey (MCPSS) and
  Supporting Regulations in 42 CFR 421.120 and 421.122
FORMS: CMS-10097

OMB NO: 0938-0916    EXPIRATION DATE: 03/31/2007
RESPS:3,400          HOURS:20,400         COSTS(000):$0
  Paid Feeding Assistants in Long Term Care Facilities and
  Supporting Regulations Contained in 42 CFR 483.160
FORMS: NONE

OMB NO: 0938-0917    EXPIRATION DATE: 02/28/2007
RESPS:38,216         HOURS:9,556          COSTS(000):$0
  Survey of Medicare Preferred Provider Organization Demonstration
FORMS: CMS-10101

OMB NO: 0938-0918    EXPIRATION DATE: 12/31/2008
RESPS:16,000         HOURS:238,000        COSTS(000):$0
  National Voluntary Hospital Reporting Initiative--Hospital
  Quality Measures
FORMS: CMS-10109

OMB NO: 0938-0919    EXPIRATION DATE: 03/31/2007
RESPS:14,400         HOURS:1,800          COSTS(000):$0
  1-800-MEDICARE Beneficiary Satisfaction Survey
FORMS: CMS-10098

OMB NO: 0938-0920    EXPIRATION DATE: 04/30/2007
RESPS:42,101,275     HOURS:3,917,643      COSTS(000):$0
  Medicaid Managed Care and Supporting Regulations in 42 CFR
  438.6, 438.8, 438.10, 438.12, 138.50, 438.56, 438.102, 438.114,
  438.202, 438.206, 438.207, 438.240, 438.242, 438.402, 438.404,
  438.406...
FORMS: CMS-10108

OMB NO: 0938-0921    EXPIRATION DATE: 05/31/2009
RESPS:480            HOURS:17,760         COSTS(000):$0
  Manufacturer Submission of Average Sales Price (ASP) Data for
  Medicare Part B Drugs and Biological and Supporting Regulations
FORMS: CMS-10110

OMB NO: 0938-0922    EXPIRATION DATE: 01/31/2008
RESPS:1,120          HOURS:2,464          COSTS(000):$0
  Instrument/tool for refinement of a prospective payment system
  for patients in inpatient psychiatric hospitals, and units: a
  pilot test
FORMS: CMS-10107

OMB NO: 0938-0924    EXPIRATION DATE: 01/31/2008
RESPS:50,000         HOURS:20,417         COSTS(000):$0
  Application for Participation in Medicare Replacement Drug
  Demonstration
FORMS: CMS-10113

OMB NO: 0938-0926    EXPIRATION DATE: 12/31/2007
RESPS:3,000          HOURS:1,500          COSTS(000):$0
  In-Center Hemodialysis CAHPS Survey
FORMS: CMS-10105

OMB NO: 0938-0929    EXPIRATION DATE: 05/31/2008
RESPS:62,500         HOURS:31,250         COSTS(000):$0
  Federal Funding of Emergency Health Services (Section 1011):
  Enrollment Application
FORMS: 10115

OMB NO: 0938-0930    EXPIRATION DATE: 11/30/2007
RESPS:1,000,000      HOURS:250,000        COSTS(000):$0
  Medicare Authorization to Disclose Personal Health Information
FORMS: CMS-10106

OMB NO: 0938-0931    EXPIRATION DATE: 02/29/2008
RESPS:1,193,945      HOURS:448,128        COSTS(000):$0
  National Provider Identifier (NPI) Application and Update Form
  and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR
  162.406
FORMS: CMS-10114

OMB NO: 0938-0932    EXPIRATION DATE: 01/31/2008
RESPS:2,753          HOURS:1,330          COSTS(000):$0
  Evaluation of PACE as a Permanent Program and a For Profit
  Demonstration
FORMS: CMS-10103

OMB NO: 0938-0933    EXPIRATION DATE: 01/31/2008
RESPS:10             HOURS:100            COSTS(000):$0
  1932 State Plan Amendment Template, State Plan Requirements, and
  Supporting Regulations in 42 CFR 438.50
FORMS: CMS-10120

OMB NO: 0938-0935    EXPIRATION DATE: 10/31/2006
RESPS:90             HOURS:2,770          COSTS(000):$0
  Medicare Advantage Applications
FORMS: CMS-10117 CMS-10118 CMS-10119 CMS-10135 CMS-10136

OMB NO: 0938-0936    EXPIRATION DATE: 08/31/2006
RESPS:101            HOURS:3,828          COSTS(000):$0
  Applications for Medicare Part D plans: PDP Plans, MA-PD Plans,
  Cost Plans, PACE organizations, SAE and EPOG
FORMS: CMS-10137

OMB NO: 0938-0938    EXPIRATION DATE: 04/30/2008
RESPS:1,600          HOURS:792            COSTS(000):$0
  Public Reporting on Quality Outcomes National Survey of Hospital
  Executives ("PRO QUO")
FORMS: CMS-10128

OMB NO: 0938-0939    EXPIRATION DATE: 06/30/2008
RESPS:2,000          HOURS:16,000         COSTS(000):$0
  Phone Surveys of Product/Service for Medicare Payment Validation
  and Supporting Regulations in 42 CFR, 405.502
FORMS: CMS-10112

OMB NO: 0938-0941    EXPIRATION DATE: 12/31/2008
RESPS:800            HOURS:19,200         COSTS(000):$0
  Medicare Care Management Performance Demonstration (MCMP)
  Standardized Ambulatory Care Quality Measure Collection
  Initiative
FORMS: 10136

OMB NO: 0938-0942    EXPIRATION DATE: 01/31/2009
RESPS:10             HOURS:790            COSTS(000):$0
  Physician Group Practice (PGP) Standardized Ambulatory Care
  Quality Measure Collection Initiative
FORMS: CMS-10134

OMB NO: 0938-0943    EXPIRATION DATE: 05/31/2008
RESPS:2,500          HOURS:1,625          COSTS(000):$0
  Evaluation of Medicare Disease Management Demonstrations
FORMS: CMS-10131

OMB NO: 0938-0944    EXPIRATION DATE: 03/31/2009
RESPS:4,830          HOURS:36,190         COSTS(000):$0
  Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and
  Prescription Drug Plans (PDP)
FORMS: CMS-10142

OMB NO: 0938-0948    EXPIRATION DATE: 12/31/2008
RESPS:500            HOURS:500            COSTS(000):$0
  HIPAA Administrative Simplification Non-Privacy Enforcement
FORMS: CMS-10148

OMB NO: 0938-0949    EXPIRATION DATE: 03/31/2009
RESPS:4,000,000      HOURS:64,539,263     COSTS(000):$0
  Health Insurance Reform Security Standards - Final Rule
FORMS: CMS-10149

OMB NO: 0938-0950    EXPIRATION DATE: 07/31/2008
RESPS:5,455,461      HOURS:6,819          COSTS(000):$0
  Appointment of Representative and Supporting Regulations in 42
  CFR 405.910
FORMS: CMS-1696

OMB NO: 0938-0951    EXPIRATION DATE: 12/31/2008
RESPS:18,200         HOURS:36,400         COSTS(000):$0
  Collection of Drug Pricing and Network Pharmacy Data from
  Medicare Prescription Drug Plans (PDP and MA-PD) and Supporting
  Regulations in 42 CFR 423.48
FORMS: CMS-10150

OMB NO: 0938-0952    EXPIRATION DATE: 01/31/2009
RESPS:7,512,000      HOURS:634,000        COSTS(000):$0
  Federal Funding of Emergency Health Services (Section 1011);
  Provider Payment Determination and On-Call Cost Forms
FORMS: CMS-10130

OMB NO: 0938-0953    EXPIRATION DATE: 06/30/2008
RESPS:4,292,400      HOURS:379,400        COSTS(000):$0
  Expedited Review Notices and Supporting Regulations Contained in
  42 CFR SEction 405.1200 and 405.1202
FORMS: CMS-10123 CMS-10124

OMB NO: 0938-0954    EXPIRATION DATE: 07/31/2008
RESPS:10             HOURS:80             COSTS(000):$0
  Medicare Part B Drug and Biological CAP and Supporting
  Regulations in 42 CFR Sections 414.906, 414.908, 414.910,
  414.914 and 414.916
FORMS: CMS-10145

OMB NO: 0938-0955    EXPIRATION DATE: 08/31/2006
RESPS:12             HOURS:480            COSTS(000):$0
  Medicare Part B Drug and Biological Competitive Acquisition
  Program Applications
FORMS: CMS-10133

OMB NO: 0938-0957    EXPIRATION DATE: 02/28/2009
RESPS:50,000         HOURS:2,025,000      COSTS(000):$0
  Retiree Drug Subsidy (RDS) Application and Instructions
FORMS: CMS-10156

OMB NO: 0938-0958    EXPIRATION DATE: 08/31/2008
RESPS:612            HOURS:10,710         COSTS(000):$0
  Monthly State File of Medicaid/Medicare Dual Eligible Enrollees
FORMS: CMS-10143

OMB NO: 0938-0960    EXPIRATION DATE: 03/31/2009
RESPS:122,000        HOURS:45,000         COSTS(000):$0
  CMS Real-Time Eligibility Agreement and MDCN Access Request
FORMS: CMS-10157

OMB NO: 0938-0963    EXPIRATION DATE: 03/31/2009
RESPS:31,200         HOURS:4,940          COSTS(000):$0
  1-800-MEDICARE Customer Experience Questionnaire
FORMS: CMS-10163

OMB NO: 0938-0964    EXPIRATION DATE: 08/31/2008
RESPS:35,439,719     HOURS:212,044,545    COSTS(000):$0
  Medicare Prescription Drug Benefit Program
FORMS: CMS-10141

OMB NO: 0938-0965    EXPIRATION DATE: 03/31/2009
RESPS:800            HOURS:133            COSTS(000):$0
  Application for Participation in Medicare Care Management
  Performance Demonstration
FORMS: CMS-10165

OMB NO: 0938-0967    EXPIRATION DATE: 11/30/2008
RESPS:50,000         HOURS:4,167          COSTS(000):$0
  Data Collection for Medicare Beneficiaries Receiving Implantable
  Cardioverter-defibrillators for Primary Prevention of Sudden
  Cardiac Death
FORMS: CMS-10151

OMB NO: 0938-0968    EXPIRATION DATE: 11/30/2008
RESPS:50,000         HOURS:4,167          COSTS(000):$0
  Collection for Medicare Bene#s Receiving FDG Positron Emissions
  Tomography for Brain, Cervical, Ovarian, Small Cell Lung, and
  Testicular Cancers
FORMS: CMS-10152

OMB NO: 0938-0969    EXPIRATION DATE: 08/31/2006
RESPS:2,900,000      HOURS:483,333        COSTS(000):$0
  Medicare Program: Complex Medical Review
FORMS: CMS-10168

OMB NO: 0938-0971    EXPIRATION DATE: 08/31/2006
RESPS:37,400         HOURS:37,400         COSTS(000):$0
  Medicare Program: Conditions of Payment of Power Mobility
  Devices, Including Power Wheelchairs and Power-Operated Vehicles
  (CMS-3017-IFC)
FORMS: CMS-10116

OMB NO: 0938-0972    EXPIRATION DATE: 12/31/2008
RESPS:1,580          HOURS:395            COSTS(000):$0
  Consumer Assessment of Health Behaviors Survey
FORMS: CMS-10160

OMB NO: 0938-0973    EXPIRATION DATE: 12/31/2008
RESPS:1,730          HOURS:346            COSTS(000):$0
  Physician Assessment of Hospital Quality Reports
FORMS: CMS-10154

OMB NO: 0938-0974    EXPIRATION DATE: 10/31/2008
RESPS:58,680         HOURS:58,680         COSTS(000):$0
  Payment Error Rate Measurement in Medicaid and the State
  Children Health Insurance Program
FORMS: CMS-10166

OMB NO: 0938-0975    EXPIRATION DATE: 11/30/2008
RESPS:35,000,000     HOURS:583,333        COSTS(000):$0
  Medicare Prescription Drug Coverage and Your Rights
FORMS: CMS-10147 CMS-10147-SP

OMB NO: 0938-0976    EXPIRATION DATE: 11/30/2008
RESPS:1,056,000      HOURS:528,000        COSTS(000):$53
  Notice of Denial of Medicare Prescription Drug Coverage
FORMS: CMS-10146 CMS-10146-SP

OMB NO: 0938-0977    EXPIRATION DATE: 05/31/2009
RESPS:6,000          HOURS:222,000        COSTS(000):$68,136
  Retiree Drug Subsidy Payment Request Instructions
FORMS: CMS-10170

OMB NO: 0938-0978    EXPIRATION DATE: 06/30/2009
RESPS:2,153,767,270  HOURS:1,017,914      COSTS(000):$0
  Coordination of Benefits between Part D Plans and Other
  Prescription Coverage Providers
FORMS: CMS-10171

OMB NO: 0938-0979    EXPIRATION DATE: 01/31/2009
RESPS:836            HOURS:6,440          COSTS(000):$0
  New Freedom Initiative - Web-based Reporting System for Grantees
FORMS: CMS-10161

OMB NO: 0938-0980    EXPIRATION DATE: 12/31/2008
RESPS:9,449          HOURS:2,363          COSTS(000):$0
  Medicare Care Improvement Survey
FORMS: CMS-10162

OMB NO: 0938-0981    EXPIRATION DATE: 12/31/2007
RESPS:2,852,000      HOURS:285,200        COSTS(000):$0
  National Implementation of Hospital Consumer Assessment of
  Health Providers and Systems (HCAHPS)
FORMS: CMS-10102

OMB NO: 0938-0982    EXPIRATION DATE: 08/31/2006
RESPS:2,418,000,000  HOURS:4,836          COSTS(000):$0
  Collection of Prescription Drug Data from MA-PD, PDP and Fallout
  Plans/Sponsors for Medicare Part D Payments
FORMS: CMS-10174

OMB NO: 0938-0983    EXPIRATION DATE: 02/28/2009
RESPS:1,220,000      HOURS:400,000        COSTS(000):$0
  Medicare EDI Enrollment Form and EDI Registration
FORMS: CMS-10164

OMB NO: 0938-0984    EXPIRATION DATE: 08/31/2006
RESPS:1,000          HOURS:3,000          COSTS(000):$0
  Certification Statement for Electronic File Interchange
  Organizations that submit NPI Data to the National Plan and
  Provider Enumeration System
FORMS: CMS-10175

OMB NO: 0938-0985    EXPIRATION DATE: 03/31/2009
RESPS:26,643         HOURS:12,416         COSTS(000):$0
  Medicare Health Support Program Medical Records Abstraction
FORMS: CMS-10172

OMB NO: 0938-0986    EXPIRATION DATE: 03/31/2009
RESPS:1,227          HOURS:307            COSTS(000):$0
  Rehabilitation Unit Criteria Work Sheet and Rehabilitation
  Hospital Criteria Work Sheet and Supporting Regulations at 42
  CFR 412.20-412.30
FORMS: CMS-437A CMS-437B

OMB NO: 0938-0987    EXPIRATION DATE: 04/30/2009
RESPS:10,000         HOURS:20,000         COSTS(000):$0
  Competitive Acquisition Program (CAP) for Medicare Part B Drugs:
  CAP Physician Election Agreement
FORMS: CMS-10167

OMB NO: 0938-0988    EXPIRATION DATE: 09/30/2006
RESPS:56             HOURS:336            COSTS(000):$0
  State Children's Health Insurance Program (SCHIP) Report on
  Payables and Receivables
FORMS: CMS-10180

OMB NO: 0938-0989    EXPIRATION DATE: 06/30/2007
RESPS:60,000,000     HOURS:15,000,000     COSTS(000):$0
  Individuals Authorized Access to the CMS Computer Services
FORMS: CMS-10173

OMB NO: 0938-0990    EXPIRATION DATE: 09/30/2006
RESPS:1,225,173      HOURS:522,204        COSTS(000):$0
  Model Creditable Coverage Disclosure Notices
FORMS: CMS-10182

OMB NO: 0938-0992    EXPIRATION DATE: 09/30/2006
RESPS:12,812         HOURS:102,496        COSTS(000):$0
  Medicare Part D Reporting Requirements
FORMS: CMS-10185

OMB NO: 0938-0993    EXPIRATION DATE: 09/30/2006
RESPS:56             HOURS:56             COSTS(000):$0
  State Plan Preprints to Implement Sections of the Deficit
  Reduction Act of 2006
FORMS: CMS-10190

OMB NO: 0938-0995    EXPIRATION DATE: 08/31/2006
RESPS:450            HOURS:1,800          COSTS(000):$0
  Strategic and Implementing Plan Regarding Specialty Hospitals -
  Section 5006 of the DRA
FORMS: CMS-10092

OMB NO: 0938-0999    EXPIRATION DATE: 06/30/2007
RESPS:957,204,707    HOURS:46,383,364     COSTS(000):$0
  Insurance Common Claims Form and Supporting Regulations at 42
  CFR Part 424 Subpart C
FORMS: CMS-1500(08-05) CMS-1490S

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
257 7,433,173,028 478,942,781 $69,179
Administration for Children and Families
OMB NO: 0970-0004    EXPIRATION DATE: 11/30/2008
RESPS:52             HOURS:13,746         COSTS(000):$0
  Annual Statistical Report on Children in Foster Homes and in
  Families Receiving Payments in Excess of the Poverty Income
  Level from a State Program
FORMS: ACF-4125

OMB NO: 0970-0017    EXPIRATION DATE: 11/30/2007
RESPS:324            HOURS:243            COSTS(000):$0
  State Plan for Child Support Collection and Establishment of
  Paternity Under Title IV-D of the Social Security Act
FORMS: OCSE-100 OCSE-21-U4

OMB NO: 0970-0030    EXPIRATION DATE: 02/29/2008
RESPS:1              HOURS:24             COSTS(000):$384
  Refugee Resettlement Program Estimates: CMA
FORMS: ORR-1

OMB NO: 0970-0033    EXPIRATION DATE: 05/31/2007
RESPS:1,146          HOURS:669            COSTS(000):$0
  Annual Survey of Refugees
FORMS: ORR-9

OMB NO: 0970-0034    EXPIRATION DATE: 09/30/2006
RESPS:900            HOURS:255            COSTS(000):$0
  ORR-3 Refugee and Entrant Unaccompanied Minor Placement Report
  ORR-4 Refugee and Entrant Unaccompanied Minor Placement Report
FORMS: ORR-3 ORR-4

OMB NO: 0970-0036    EXPIRATION DATE: 05/31/2007
RESPS:4              HOURS:744            COSTS(000):$27
  Quarterly Performance Report
FORMS: ORR-6

OMB NO: 0970-0037    EXPIRATION DATE: 07/31/2008
RESPS:55             HOURS:14             COSTS(000):$0
  LIHEAP Quarterly Allocation Estimates
FORMS: ACF-535

OMB NO: 0970-0043    EXPIRATION DATE: 06/30/2009
RESPS:50             HOURS:425            COSTS(000):$0
  Refugee State of Origin Report
FORMS: ORR-11

OMB NO: 0970-0060    EXPIRATION DATE: 10/31/2006
RESPS:184            HOURS:2,108          COSTS(000):$0
  Low Income Home Energy Assistance Program (LIHEAP) Household
  Report
FORMS: NONE

OMB NO: 0970-0075    EXPIRATION DATE: 10/31/2008
RESPS:180            HOURS:103            COSTS(000):$0
  Application Requirements for the Low Income Home Energy
  Assistance Program (LIHEAP) Model Plan
FORMS: NONE

OMB NO: 0970-0076    EXPIRATION DATE: 01/31/2008
RESPS:51             HOURS:173            COSTS(000):$0
  Low Income Home Energy Assistance Program (LIHEAP) Grantee Survey
FORMS: ACF-284

OMB NO: 0970-0085    EXPIRATION DATE: 01/31/2008
RESPS:54             HOURS:662,138        COSTS(000):$0
  Provision of Services in Interstate Child Support Enforcement:
  Standard Forms
FORMS: NONE

OMB NO: 0970-0106    EXPIRATION DATE: 04/30/2008
RESPS:177            HOURS:531            COSTS(000):$0
  Low Income Home Energy Assistance Program (LIHEAP) Carryout and
  Reallotment Report
FORMS: NONE

OMB NO: 0970-0114    EXPIRATION DATE: 06/30/2008
RESPS:28             HOURS:4,552          COSTS(000):$0
  Child Care and Development Fund Plan for States/Territories for
  FY 2006-2007
FORMS: ACF-118

OMB NO: 0970-0121    EXPIRATION DATE: 10/31/2006
RESPS:70             HOURS:2,660          COSTS(000):$0
  Low Income Home Energy Assistance (LIHEAP) Leveraging Report
FORMS: NONE

OMB NO: 0970-0123    EXPIRATION DATE: 09/30/2007
RESPS:1,070          HOURS:58,557         COSTS(000):$512
  National Extranet Optimized Runaway and Homeless Youth
  Management Information System (NEORHYMIS)
FORMS: NONE

OMB NO: 0970-0139    EXPIRATION DATE: 04/30/2007
RESPS:11,960         HOURS:472,400        COSTS(000):$0
  ACF Uniform Project Description (UPD)
FORMS: NONE

OMB NO: 0970-0145    EXPIRATION DATE: 09/30/2008
RESPS:54             HOURS:891            COSTS(000):$0
  Temporary Assistance for Needy Families (TANF) State Plan
  Guidance
FORMS: NONE

OMB NO: 0970-0148    EXPIRATION DATE: 11/30/2006
RESPS:2,590          HOURS:1,737,618      COSTS(000):$0
  42 C.F.R. 1304 Head Start Program Performance Standards
FORMS: NONE

OMB NO: 0970-0150    EXPIRATION DATE: 08/31/2006
RESPS:56             HOURS:2,240          COSTS(000):$280
  Child Care and Development Fund Annual Aggregate Report
FORMS: ACF-800

OMB NO: 0970-0151    EXPIRATION DATE: 06/30/2009
RESPS:8,668          HOURS:6,861          COSTS(000):$0
  Head Start Family and Child Experience Survey (FACES 2006)
FORMS: NONE

OMB NO: 0970-0152    EXPIRATION DATE: 01/31/2008
RESPS:1              HOURS:9,890          COSTS(000):$0
  Administrative Subpoena
FORMS: NONE

OMB NO: 0970-0153    EXPIRATION DATE: 01/31/2008
RESPS:1              HOURS:27,346         COSTS(000):$0
  Notice of Lien
FORMS: NONE

OMB NO: 0970-0154    EXPIRATION DATE: 05/31/2007
RESPS:216,000        HOURS:980,230        COSTS(000):$0
  Order to Withhold Income for Child Support and Notice of an
  Order to Withhold Income for Child Support
FORMS: NONE

OMB NO: 0970-0155    EXPIRATION DATE: 06/30/2008
RESPS:52             HOURS:3,328          COSTS(000):$0
  Community-Based Family Resource and Support Grants
FORMS: NONE

OMB NO: 0970-0157    EXPIRATION DATE: 12/31/2007
RESPS:1              HOURS:1,200          COSTS(000):$0
  Guidance for the Tribal Temporary Assistance for Needy Families
  (TANF) Program
FORMS: NONE

OMB NO: 0970-0159    EXPIRATION DATE: 07/31/2008
RESPS:3              HOURS:600            COSTS(000):$0
  Statewide Automated Child Welfare Information System (SACWIS)
  Assessment Review Guide
FORMS: NONE

OMB NO: 0970-0160    EXPIRATION DATE: 12/31/2006
RESPS:10             HOURS:200            COSTS(000):$0
  Procedures for Requests from Tribal Child Care Lead Agencies to
  Use Child Care and Development Fund (CCDF) for Construction or
  Major Renovation of Child Care Facilities
FORMS: NONE

OMB NO: 0970-0161    EXPIRATION DATE: 04/30/2007
RESPS:7,074          HOURS:2,535          COSTS(000):$128
  Federal Tax Offset, Administrative Offset, and Passprot Denial
  Programs
FORMS: NONE

OMB NO: 0970-0163    EXPIRATION DATE: 03/31/2007
RESPS:4              HOURS:1,120          COSTS(000):$0
  Child Care and Development Fund Quarterly Financial Report
FORMS: ACF-696

OMB NO: 0970-0166    EXPIRATION DATE: 04/30/2007
RESPS:60,000,000     HOURS:1,962,431      COSTS(000):$25,000
  National Directionary of New Hires
FORMS: NONE

OMB NO: 0970-0167    EXPIRATION DATE: 05/31/2009
RESPS:224            HOURS:4,480          COSTS(000):$317
  Child Care Case-Level Report
FORMS: ACF-801

OMB NO: 0970-0171    EXPIRATION DATE: 06/30/2008
RESPS:862,043        HOURS:143,988        COSTS(000):$0
  Required Data Elements for Paternity Establishment Affidavits
FORMS: NONE

OMB NO: 0970-0173    EXPIRATION DATE: 11/30/2007
RESPS:1              HOURS:630            COSTS(000):$80
  Request for State Data Needed to Determine the Amount of a
  Tribal Family Assistance Grant
FORMS: NONE

OMB NO: 0970-0174    EXPIRATION DATE: 09/30/2006
RESPS:79             HOURS:1,575          COSTS(000):$0
  Native Employment Works (NEW) Program Plan Guidance and Program
  Report
FORMS: NONE

OMB NO: 0970-0175    EXPIRATION DATE: 06/30/2008
RESPS:862,043        HOURS:143,099        COSTS(000):$0
  Voluntary Establishment of Paternity
FORMS: NONE

OMB NO: 0970-0177    EXPIRATION DATE: 08/31/2008
RESPS:54             HOURS:378            COSTS(000):$0
  OCSE-157 Child Support Enforcement Annual Data Report
FORMS: NONE

OMB NO: 0970-0181    EXPIRATION DATE: 07/31/2009
RESPS:432            HOURS:3,456          COSTS(000):$2,000
  Child Support Enforcement Program Financial Report Child Support
  Enforcement Program Quarterly Report of Collection
FORMS: OCSE34A OCSE396A

OMB NO: 0970-0183    EXPIRATION DATE: 04/30/2008
RESPS:648            HOURS:1,296          COSTS(000):$0
  Project 1099
FORMS: NONE

OMB NO: 0970-0186    EXPIRATION DATE: 02/28/2009
RESPS:1              HOURS:15,552         COSTS(000):$0
  Methodology for Determining Whether an Increase in a State's
  Child Poverty Rate is the Result of the TANF Program
FORMS: NONE

OMB NO: 0970-0193    EXPIRATION DATE: 08/31/2006
RESPS:200            HOURS:8,200          COSTS(000):$0
  45 CFR 1309 Head Start Facilities Purchase, Major Renovation and
  Construction
FORMS: NONE

OMB NO: 0970-0195    EXPIRATION DATE: 04/30/2008
RESPS:232            HOURS:1,740          COSTS(000):$0
  Child Care and Development Fund Annual Financial Report for
  Tribes (CCDF)
FORMS: ACF-696T

OMB NO: 0970-0196    EXPIRATION DATE: 10/31/2007
RESPS:18,337         HOURS:9,168          COSTS(000):$17
  Financial Institution Data Match
FORMS: NONE

OMB NO: 0970-0198    EXPIRATION DATE: 08/31/2008
RESPS:265            HOURS:5,035          COSTS(000):$0
  Child Care and Development Fund Plan Preprint
FORMS: ACF-118-A

OMB NO: 0970-0199    EXPIRATION DATE: 09/30/2006
RESPS:332            HOURS:543,382        COSTS(000):$13,500
  TANF Data Report (Includes TANF Sampling and Statistical Methods
  Manual), SSP-MOE Data Report (Includes TANF Sampling and
  Statistical Methods Manual)
FORMS: ACF-199 ACF-209

OMB NO: 0970-0202    EXPIRATION DATE: 06/30/2009
RESPS:950            HOURS:1,425          COSTS(000):$0
  National Survey of Child and Adolescent Well-Being: Infant
  Follow-Up
FORMS: NONE

OMB NO: 0970-0204    EXPIRATION DATE: 06/30/2009
RESPS:324            HOURS:4,860          COSTS(000):$0
  State Child Access Program Survey
FORMS: NONE

OMB NO: 0970-0205    EXPIRATION DATE: 02/28/2009
RESPS:4              HOURS:3,536          COSTS(000):$0
  IV-E Foster Care and Adoption Assistance Financial Report
FORMS: ACF-IV-E-1

OMB NO: 0970-0207    EXPIRATION DATE: 09/30/2006
RESPS:1,600          HOURS:52,800         COSTS(000):$0
  Head Start Grant Application and Budget Instrument
FORMS: NONE

OMB NO: 0970-0209    EXPIRATION DATE: 03/31/2009
RESPS:1,018          HOURS:297            COSTS(000):$0
  Online Interstate Referral Guide (IRG)
FORMS: NONE

OMB NO: 0970-0214    EXPIRATION DATE: 10/31/2006
RESPS:42             HOURS:14,072         COSTS(000):$0
  Title IV-E Foster Care Eligibility Reviews, Child and Family
  Services Reviews
FORMS: NONE

OMB NO: 0970-0215    EXPIRATION DATE: 09/30/2006
RESPS:336            HOURS:106,624        COSTS(000):$1,759
  Final Tribal TANF Data Report
FORMS: ACF-343

OMB NO: 0970-0218    EXPIRATION DATE: 04/30/2007
RESPS:150            HOURS:46,462         COSTS(000):$0
  Tribal Child Support Direct Funding Regulation - Final
FORMS: NONE

OMB NO: 0970-0222    EXPIRATION DATE: 02/29/2008
RESPS:726,516        HOURS:123,507        COSTS(000):$11
  National Medical Support Notice
FORMS: NONE

OMB NO: 0970-0223    EXPIRATION DATE: 03/31/2007
RESPS:54             HOURS:208,764        COSTS(000):$450
  State Self-Assessment Review and Report
FORMS: NONE

OMB NO: 0970-0230    EXPIRATION DATE: 02/28/2009
RESPS:108            HOURS:1,728          COSTS(000):$0
  Revised Reporting Requirements and Transmission Layouts on TANF
  HPB
FORMS: ACF-300

OMB NO: 0970-0234    EXPIRATION DATE: 05/31/2008
RESPS:56             HOURS:6,160          COSTS(000):$0
  Social Services Block Grant Postexpenditure Report
FORMS: NONE

OMB NO: 0970-0245    EXPIRATION DATE: 06/30/2009
RESPS:52             HOURS:3,952          COSTS(000):$0
  Court Improvement Program
FORMS: NONE

OMB NO: 0970-0246    EXPIRATION DATE: 01/31/2007
RESPS:1,197          HOURS:1,139          COSTS(000):$0
  Rural Welfare-to-Work Strategies Demonstration Evaluation Project
FORMS: NONE

OMB NO: 0970-0247    EXPIRATION DATE: 03/31/2009
RESPS:4              HOURS:1,728          COSTS(000):$0
  Temporary Assistance for Needy Families Quarterly Financial
  Report
FORMS: ACF-196

OMB NO: 0970-0248    EXPIRATION DATE: 08/31/2006
RESPS:4              HOURS:32,882         COSTS(000):$0
  Caseload Reduction Documentation Process, the Reasonable
  Cause/Corrective Compliance Documentation Process, and the
  Annual Report on State MOE Programs
FORMS: ACF-202 ACF-204

OMB NO: 0970-0249    EXPIRATION DATE: 07/31/2009
RESPS:924,458        HOURS:924,458        COSTS(000):$0
  Design and Field Testing of Head Start National Reporting System
  on Child Outcomes
FORMS: NONE

OMB NO: 0970-0251    EXPIRATION DATE: 07/31/2007
RESPS:5,459          HOURS:2,184          COSTS(000):$0
  HHS/ACF/ASPE/DOL Enhanced Services for the Hard-to-Employ
  Demonstration and Evaluation Project Baseline Survey (Revised)
FORMS: NONE

OMB NO: 0970-0253    EXPIRATION DATE: 08/31/2006
RESPS:4,500          HOURS:3,800          COSTS(000):$0
  Multi-site Evaluation of Foster Youth Programs
FORMS: NONE

OMB NO: 0970-0255    EXPIRATION DATE: 07/31/2008
RESPS:56             HOURS:1,120          COSTS(000):$22
  Child Care Report for High Performance Bonus
FORMS: ACF-900

OMB NO: 0970-0257    EXPIRATION DATE: 01/31/2007
RESPS:312            HOURS:499            COSTS(000):$0
  "Building Strong Families Demonstration and Evaluation"
FORMS: NONE

OMB NO: 0970-0260    EXPIRATION DATE: 07/31/2009
RESPS:275            HOURS:275            COSTS(000):$0
  Extension to Head Start Transportation Requirements
FORMS: NONE

OMB NO: 0970-0261    EXPIRATION DATE: 03/31/2007
RESPS:1              HOURS:18,200         COSTS(000):$0
  Grants Application Data Summary Administrative for Native
  Americans SEDS Applecation Information
FORMS: NONE

OMB NO: 0970-0262    EXPIRATION DATE: 03/31/2007
RESPS:443            HOURS:332            COSTS(000):$0
  Migrant and Seasonal Head Start Research Design Development
  Project
FORMS: NONE

OMB NO: 0970-0263    EXPIRATION DATE: 04/30/2007
RESPS:1              HOURS:18,200         COSTS(000):$0
  Grant Application Data Summary Administration for Native
  Americans Environmental Application Information
FORMS: NONE

OMB NO: 0970-0264    EXPIRATION DATE: 04/30/2007
RESPS:1              HOURS:18,200         COSTS(000):$0
  Grant Application Data Summary Administration for Native
  Americans Language Application Information
FORMS: NONE

OMB NO: 0970-0265    EXPIRATION DATE: 06/30/2007
RESPS:1              HOURS:300            COSTS(000):$0
  ANA Consultant and Evaluator Qualifications Form
FORMS: NONE

OMB NO: 0970-0266    EXPIRATION DATE: 08/31/2007
RESPS:1,000          HOURS:12,500         COSTS(000):$763
  Mentoring Children of Prisoners Data Collection Process (MCPDCP)
FORMS: NONE

OMB NO: 0970-0267    EXPIRATION DATE: 04/30/2008
RESPS:13,720         HOURS:2,744          COSTS(000):$0
  Fourth National Incidence Study of Child Abus and Neglect (NIS-4)
FORMS: NONE

OMB NO: 0970-0268    EXPIRATION DATE: 09/30/2007
RESPS:216            HOURS:864            COSTS(000):$0
  Itemized Undistributed Collections
FORMS: SCHED.-UDC

OMB NO: 0970-0271    EXPIRATION DATE: 09/30/2007
RESPS:51             HOURS:8,670          COSTS(000):$0
  Section 510 State Abstinence Education Grant Program Guidance
  and Forms
FORMS: NONE

OMB NO: 0970-0272    EXPIRATION DATE: 08/31/2006
RESPS:119            HOURS:714            COSTS(000):$0
  Maternal and Child Health Bureau Common Grant Guidance for
  Discretionay Grants
FORMS: NONE

OMB NO: 0970-0273    EXPIRATION DATE: 03/31/2008
RESPS:96,000         HOURS:29,520         COSTS(000):$0
  Building Strong Families - Baseline
FORMS: NONE

OMB NO: 0970-0276    EXPIRATION DATE: 06/30/2009
RESPS:4,760          HOURS:2,973          COSTS(000):$0
  Rhode Island 15-Month Follow-UP Survey Amendment
FORMS: NONE

OMB NO: 0970-0277    EXPIRATION DATE: 05/31/2008
RESPS:2,148          HOURS:3,468          COSTS(000):$0
  Evaluation of the Early Head Start Enhanced Home Visiting Pilot
  Project
FORMS: NONE

OMB NO: 0970-0278    EXPIRATION DATE: 06/30/2008
RESPS:108,000        HOURS:4,250          COSTS(000):$122
  Family Reunification Instruments
FORMS: NONE

OMB NO: 0970-0280    EXPIRATION DATE: 10/31/2008
RESPS:286            HOURS:1,716          COSTS(000):$0
  Family Violence Prevention and Services: Grants to States;
  Native American Tribes and Alaskan Native Villages; and State
  Domestic Violence Coalitions
FORMS: NONE

OMB NO: 0970-0281    EXPIRATION DATE: 07/31/2008
RESPS:90             HOURS:270            COSTS(000):$0
  Supporting Healthy Marriage Project Focus Group Protocol
FORMS: NONE

OMB NO: 0970-0283    EXPIRATION DATE: 08/31/2008
RESPS:400            HOURS:440            COSTS(000):$0
  Evaluation of the Community Healthy Marriage Initiative
  Implementation Study
FORMS: NONE

OMB NO: 0970-0284    EXPIRATION DATE: 08/31/2006
RESPS:957            HOURS:1,223          COSTS(000):$0
  The Head Start Training and Technical Assistance Quality
  Assurance Study
FORMS: NONE

OMB NO: 0970-0285    EXPIRATION DATE: 08/31/2008
RESPS:1,750          HOURS:875            COSTS(000):$0
  Employment Retention and Advancement Evaluation 42-month Survey
FORMS: NONE

OMB NO: 0970-0286    EXPIRATION DATE: 08/31/2008
RESPS:245            HOURS:237            COSTS(000):$0
  Exploring the Collection of Marriage and Divorce Statistics at
  the National, State, and Local Levels
FORMS: NONE

OMB NO: 0970-0287    EXPIRATION DATE: 08/31/2008
RESPS:12,500         HOURS:13,845         COSTS(000):$0
  Fourth National Incidence Study of Child Abuse and Neglect
  (NIS-4) 2nd submission
FORMS: NONE

OMB NO: 0970-0288    EXPIRATION DATE: 10/31/2008
RESPS:263            HOURS:1,665          COSTS(000):$0
  Improving Child Welfare Outcomes through Systems of Care
FORMS: NONE

OMB NO: 0970-0289    EXPIRATION DATE: 08/31/2008
RESPS:61             HOURS:61,000         COSTS(000):$0
  Annual Report on Progress - University Centers for Excellence in
  Developmental Disabilities Education, Research, and Service
FORMS: NONE

OMB NO: 0970-0290    EXPIRATION DATE: 10/31/2008
RESPS:54             HOURS:1,296          COSTS(000):$0
  Improper Payments Information Survey for the TANF Program
FORMS: NONE

OMB NO: 0970-0291    EXPIRATION DATE: 10/31/2008
RESPS:54             HOURS:1,296          COSTS(000):$0
  Improper Payments Informaiton Survey for the CCDF Program
FORMS: NONE

OMB NO: 0970-0293    EXPIRATION DATE: 12/31/2008
RESPS:1,575          HOURS:583            COSTS(000):$0
  Compassion Capital Fund Program Evaluation-Baseline and Follow-Up
FORMS: NONE

OMB NO: 0970-0295    EXPIRATION DATE: 11/30/2008
RESPS:348            HOURS:656            COSTS(000):$0
  The National Evaluation of the Court Improvement Program
FORMS: NONE

OMB NO: 0970-0296    EXPIRATION DATE: 12/31/2006
RESPS:1,042          HOURS:899            COSTS(000):$0
  Evaluation of Refugee Social Services (RSS) and Targeted
  Assistance Formula Grant (TAG) Programs: Data Collection
FORMS: NONE

OMB NO: 0970-0297    EXPIRATION DATE: 01/31/2009
RESPS:180            HOURS:60             COSTS(000):$0
  Compassion Capital Fund Evaluation-Initial Outcome Study
FORMS: NONE

OMB NO: 0970-0298    EXPIRATION DATE: 02/28/2009
RESPS:433,620        HOURS:3,878          COSTS(000):$0
  Field Test of Social-Emotional Measures and Modified Assessment
  Measure for the Head Start National Reporting System
FORMS: NONE

OMB NO: 0970-0299    EXPIRATION DATE: 05/31/2009
RESPS:4,000          HOURS:3,000          COSTS(000):$0
  Supporting Healthy Marriage Project Baseline Data Collection
FORMS: NONE

OMB NO: 0970-0300    EXPIRATION DATE: 05/31/2009
RESPS:324            HOURS:276            COSTS(000):$0
  Sanction Policies Task Order
FORMS: NONE

OMB NO: 0970-0301    EXPIRATION DATE: 06/30/2009
RESPS:113            HOURS:117            COSTS(000):$0
  TANF Time Limits Interview Guides for Site Visits
FORMS: NONE

OMB NO: 0970-0302    EXPIRATION DATE: 07/31/2009
RESPS:1,680          HOURS:1,260          COSTS(000):$0
  Follow-up Study of Issues Affecting the Duration of Child Care
  Subsidies
FORMS: NONE

OMB NO: 0970-0303    EXPIRATION DATE: 07/31/2009
RESPS:1,498          HOURS:177            COSTS(000):$0
  National Clearinghouse on Child Abuse and Neglect Information
  (CAN) and NAIC
FORMS: NONE

OMB NO: 0970-0304    EXPIRATION DATE: 07/31/2009
RESPS:3,148          HOURS:2,803          COSTS(000):$0
  Building Strong Families Demonstration and Evaluation -
  Implementation and Impact Study
FORMS: NONE

OMB NO: 0970-0306    EXPIRATION DATE: 07/31/2009
RESPS:23,556         HOURS:3,693          COSTS(000):$0
  Evaluation of Child Care Subsidy Strategies; Massachusetts,
  Illinois, and Washington
FORMS: ACYF-05-00091

OMB NO: 0970-0307    EXPIRATION DATE: 12/31/2006
RESPS:208            HOURS:7,904          COSTS(000):$0
  Court Improvement Program-New Grants
FORMS: SF-424 SF-424-A

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
105 64,377,599 8,610,187 $45,372
Office of Human Development Services
OMB NO: 0980-0017    EXPIRATION DATE: 04/30/2008
RESPS:2,690          HOURS:10,760         COSTS(000):$0
  Head Start Program Information Report
FORMS: NONE

OMB NO: 0980-0047    EXPIRATION DATE: 10/31/2008
RESPS:1              HOURS:64,075         COSTS(000):$0
  Child & Family Services Plan (CFSP). Annual Progress & Services
  Report (APSR), & Annual Budget Expenses Request & Estimated
  Expenditures (CFS-101)
FORMS: CFS-101

OMB NO: 0980-0140    EXPIRATION DATE: 10/31/2007
RESPS:701,461        HOURS:1,823,900      COSTS(000):$0
  Case Plan Requirement, Title IV-E of the Social Security Act
FORMS: NONE

OMB NO: 0980-0141    EXPIRATION DATE: 11/30/2008
RESPS:12             HOURS:180            COSTS(000):$0
  State Plan for Foster Care and Adoption Assistance: Title IV-E
  of the Social Security Act
FORMS: NONE

OMB NO: 0980-0160    EXPIRATION DATE: 11/30/2008
RESPS:57             HOURS:2,508          COSTS(000):$0
  Developmental Disabilities Protection and Advocacy Program
  Performance Report
FORMS: NONE

OMB NO: 0980-0162    EXPIRATION DATE: 05/31/2009
RESPS:1              HOURS:4,400          COSTS(000):$0
  Developmental Disabilities State Plan
FORMS: NONE

OMB NO: 0980-0172    EXPIRATION DATE: 02/28/2009
RESPS:1              HOURS:2,420          COSTS(000):$0
  Developmental Disabilities Council Program Performance Report
FORMS: NONE

OMB NO: 0980-0196    EXPIRATION DATE: 11/30/2008
RESPS:52             HOURS:3,120          COSTS(000):$0
  Application and Program Reporting Requirements for Children's
  Justice Act Grants
FORMS: NONE

OMB NO: 0980-0204    EXPIRATION DATE: 10/31/2006
RESPS:1              HOURS:18,850         COSTS(000):$0
  Objective Work Plan (OWP) and Project Abstract
FORMS: NONE

OMB NO: 0980-0212    EXPIRATION DATE: 05/31/2009
RESPS:55             HOURS:440            COSTS(000):$0
  Financial Status Reporting Form for Program of State Council on
  Developmental Disabilities
FORMS: ADD02/SF269-SUP

OMB NO: 0980-0229    EXPIRATION DATE: 10/31/2006
RESPS:52             HOURS:6,068          COSTS(000):$106
  National Child Abuse and Neglect Data System (NCANDS)
FORMS: NONE

OMB NO: 0980-0241    EXPIRATION DATE: 12/31/2007
RESPS:263            HOURS:9,205          COSTS(000):$0
  Child Care and Development Fund Tribal Annual Report
FORMS: ACF-700

OMB NO: 0980-0242    EXPIRATION DATE: 08/31/2006
RESPS:1              HOURS:260            COSTS(000):$0
  45 C.F.R. 1303 Appeal Procedures for Head Start Grantees and
  Current or former Delegate Agencies
FORMS: NONE

OMB NO: 0980-0243    EXPIRATION DATE: 03/31/2009
RESPS:2,700          HOURS:5,000          COSTS(000):$0
  Head Start Grants Administration
FORMS: NONE

OMB NO: 0980-0266    EXPIRATION DATE: 02/29/2008
RESPS:1,028          HOURS:616            COSTS(000):$0
  Voluntary Survey of Program Partners to Implement Executive
  Order 12862 within the Administration for Children Families
FORMS: NONE

OMB NO: 0980-0267    EXPIRATION DATE: 08/31/2008
RESPS:2              HOURS:309,077        COSTS(000):$0
  Adoption and Foster Care Analysis and Reporting System (AFCARS),
  Title IV-B & IV-E
FORMS: NONE

OMB NO: 0980-0270    EXPIRATION DATE: 08/31/2006
RESPS:1              HOURS:2,508          COSTS(000):$1,710
  Developmental Disabilities Protection and Advocacy Statement of
  Goals and Priorities
FORMS: NONE

OMB NO: 0980-0271    EXPIRATION DATE: 01/31/2008
RESPS:3,373,359      HOURS:164,360        COSTS(000):$233
  Computerized Support Enforcement Systems - Final rule
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
18 4,081,737 2,427,747 $2,049
Administration on Aging
OMB NO: 0985-0004    EXPIRATION DATE: 08/31/2007
RESPS:112            HOURS:112            COSTS(000):$0
  Supplemental Form to the Financial Status Report for all AoA
  Title III Grantees
FORMS: NONE

OMB NO: 0985-0005    EXPIRATION DATE: 06/30/2009
RESPS:52             HOURS:10,258         COSTS(000):$0
  State Annual Long-Term Care Ombudsman Report
FORMS: NONE

OMB NO: 0985-0006    EXPIRATION DATE: 09/30/2007
RESPS:600            HOURS:12,000         COSTS(000):$0
  Performance Progress Reports for Title IV Grantees
FORMS: NONE

OMB NO: 0985-0007    EXPIRATION DATE: 08/31/2006
RESPS:2              HOURS:729            COSTS(000):$0
  Program Performance Report, Title VI of the Older Americans Act.
  (Grants for Native Americns for Nutritional and Supportive
  Services)
FORMS: NONE

OMB NO: 0985-0008    EXPIRATION DATE: 03/31/2007
RESPS:1              HOURS:127,019        COSTS(000):$0
  State Program Report for Titles III and VII of the Older
  Americans Act
FORMS: NONE

OMB NO: 0985-0009    EXPIRATION DATE: 08/31/2008
RESPS:56             HOURS:28             COSTS(000):$0
  Certification of Maintenance of Effort
FORMS: NONE

OMB NO: 0985-0018    EXPIRATION DATE: 03/31/2007
RESPS:500            HOURS:5,000          COSTS(000):$0
  AoA Uniform Project Description
FORMS: NONE

OMB NO: 0985-0019    EXPIRATION DATE: 06/30/2007
RESPS:2,000          HOURS:500            COSTS(000):$0
  AoA Nutrition and Physical Activity Campaign
FORMS: NONE

OMB NO: 0985-0021    EXPIRATION DATE: 05/31/2008
RESPS:657            HOURS:657            COSTS(000):$0
  2005 National Survey of Area Agencies on Aging
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
9 3,980 156,303 $0
Departmental Management
OMB NO: 0990-0001    EXPIRATION DATE: 08/31/2006
RESPS:200            HOURS:2,400          COSTS(000):$150
  Application of Waiver of the 2 Year Foreign Residence
  Requirement of the Exchange Visitor Program
FORMS: HHS-426

OMB NO: 0990-0115    EXPIRATION DATE: 11/30/2007
RESPS:5,357          HOURS:883,905        COSTS(000):$0
  HHS Acquisition Regulation - Solicitation and Contracts
FORMS: NONE

OMB NO: 0990-0129    EXPIRATION DATE: 03/31/2009
RESPS:1,242          HOURS:10,556         COSTS(000):$0
  Special Programs Affecting Acquisition (HHSAR Part 370)
FORMS: NONE

OMB NO: 0990-0130    EXPIRATION DATE: 03/31/2009
RESPS:1,921          HOURS:3,842          COSTS(000):$0
  Solicitation Provisions and Contracts Clauses (HHSAR Part 352)
FORMS: NONE

OMB NO: 0990-0131    EXPIRATION DATE: 06/30/2009
RESPS:110            HOURS:2,200          COSTS(000):$0
  HHS Acquisition Regulation - HHSAR Part 342 - Contract
  Administration
FORMS: NONE

OMB NO: 0990-0133    EXPIRATION DATE: 03/31/2009
RESPS:1              HOURS:40             COSTS(000):$0
  HHS Acquisition Regulation - HHSAR Part 333 - Disputes and
  Appeals
FORMS: NONE

OMB NO: 0990-0136    EXPIRATION DATE: 08/31/2006
RESPS:430            HOURS:3,440          COSTS(000):$0
  HHS Acquisition Regulation - HHSAR Part 324 - Protection of
  Privacy and Freedom of Information
FORMS: NONE

OMB NO: 0990-0150    EXPIRATION DATE: 09/30/2007
RESPS:1              HOURS:1              COSTS(000):$0
  Uniform Relocation and Real Property Acquisition Under Federal
  and Federally Assisted programs
FORMS: NONE

OMB NO: 0990-0162    EXPIRATION DATE: 03/31/2007
RESPS:48             HOURS:2,744          COSTS(000):$0
  State Medicaid Fraud Control Units Annual Report and
  Recertification Application
FORMS: NONE

OMB NO: 0990-0169    EXPIRATION DATE: 08/31/2006
RESPS:4,000          HOURS:280,000        COSTS(000):$0
  Uniform Administrative Requirements for Grantrs and Cooperative
  Agreements to State and Local Governments
FORMS: NONE

OMB NO: 0990-0208    EXPIRATION DATE: 05/31/2009
RESPS:30,000         HOURS:1,000          COSTS(000):$0
  Applicant Background Survey
FORMS: NONE

OMB NO: 0990-0220    EXPIRATION DATE: 01/31/2007
RESPS:8,180          HOURS:1,577          COSTS(000):$0
  Voluntary Industry Partner Surveys to Implement E.O. 12862
FORMS: NONE

OMB NO: 0990-0221    EXPIRATION DATE: 04/30/2007
RESPS:89             HOURS:2,937          COSTS(000):$1,036
  Family Planning Annual Report: Forms and Instructions
FORMS: NONE

OMB NO: 0990-0243    EXPIRATION DATE: 06/30/2007
RESPS:4,000          HOURS:64,000         COSTS(000):$0
  OCR Pre-granted Automation Project
FORMS: NONE

OMB NO: 0990-0260    EXPIRATION DATE: 12/31/2008
RESPS:446,334        HOURS:1,105,834      COSTS(000):$0
  Protection of Human Subjects: Common Rule (56 FR 28003)
FORMS: NONE

OMB NO: 0990-0263    EXPIRATION DATE: 11/30/2008
RESPS:166,667        HOURS:55,500         COSTS(000):$0
  Protection of Human Subjects Assurance Identification/IRB
  Certification/Declaration of Exemption
FORMS: NONE

OMB NO: 0990-0268    EXPIRATION DATE: 03/31/2009
RESPS:5,437          HOURS:2,513          COSTS(000):$0
  Service Use and Transition of Private Long-term Care Insurance
FORMS: NONE

OMB NO: 0990-0269    EXPIRATION DATE: 07/31/2009
RESPS:12,400         HOURS:9,300          COSTS(000):$0
  Complaint Forms for Discrimination; Health Information Privacy
  Complaints
FORMS: NONE

OMB NO: 0990-0273    EXPIRATION DATE: 03/31/2007
RESPS:1,352          HOURS:286            COSTS(000):$0
  Evaluation of the Office of Minority Health Resource Center
FORMS: NONE

OMB NO: 0990-0274    EXPIRATION DATE: 03/31/2007
RESPS:173            HOURS:175            COSTS(000):$0
  Survey of State and Local Contracting Officials on Contracting
  for Social Services Under Charitable Choices
FORMS: NONE

OMB NO: 0990-0275    EXPIRATION DATE: 06/30/2007
RESPS:616            HOURS:2,772          COSTS(000):$0
  Implementation of an Internet & Paper-Based Uniform Data Set for
  OMH-funded Activities
FORMS: NONE

OMB NO: 0990-0276    EXPIRATION DATE: 08/31/2007
RESPS:301            HOURS:75             COSTS(000):$0
  Assessment Study of the Uses of Healthier US and Healthy People
  2010
FORMS: NONE

OMB NO: 0990-0278    EXPIRATION DATE: 01/31/2008
RESPS:30,000         HOURS:22,500         COSTS(000):$0
  Federalwide Assurance (FWA)
FORMS: NONE

OMB NO: 0990-0279    EXPIRATION DATE: 01/31/2008
RESPS:5,000          HOURS:3,500          COSTS(000):$0
  Institutional Review Board/Independent Ethics Committee
  Registration Form
FORMS: NONE

OMB NO: 0990-0280    EXPIRATION DATE: 04/30/2008
RESPS:3,900          HOURS:1,300          COSTS(000):$0
  Reporting Suspected Research Misconduct in Biomedical and
  Behavioral Research
FORMS: NONE

OMB NO: 0990-0281    EXPIRATION DATE: 06/30/2008
RESPS:1,742          HOURS:4,200          COSTS(000):$0
  Prevention Communication Formative Research
FORMS: NONE

OMB NO: 0990-0282    EXPIRATION DATE: 03/31/2008
RESPS:2,569          HOURS:1,285          COSTS(000):$0
  Wave 4 Survey of Youth for the Federal Evaluation of Initiatives
  Funded Under SEction 510 of the Maternal and Child Health Block
  Grant
FORMS: NONE

OMB NO: 0990-0285    EXPIRATION DATE: 06/30/2008
RESPS:25             HOURS:50             COSTS(000):$0
  Office for Human Research Protections, Fellowship Program
FORMS: NONE

OMB NO: 0990-0286    EXPIRATION DATE: 08/31/2008
RESPS:30             HOURS:30             COSTS(000):$0
  Homeless, Veterans, Women, Healthcare
FORMS: NONE

OMB NO: 0990-0287    EXPIRATION DATE: 06/30/2008
RESPS:4              HOURS:19,728         COSTS(000):$0
  HHS Research Misconduct Final Rule
FORMS: NONE

OMB NO: 0990-0288    EXPIRATION DATE: 08/31/2008
RESPS:392,650        HOURS:3,510          COSTS(000):$0
  National Heart, Lung, and Blood Institute (NHLBI) The Heart
  Truth Professional Education Campaign Provider Pretest/Posttest
FORMS: NONE

OMB NO: 0990-0289    EXPIRATION DATE: 09/30/2008
RESPS:260            HOURS:1,635          COSTS(000):$0
  Evaluation of HIV Prevention Programs for Women
FORMS: NONE

OMB NO: 0990-0290    EXPIRATION DATE: 09/30/2008
RESPS:12,600         HOURS:6,300          COSTS(000):$0
  Adolescent Family Life Care Program Core Evaluation
FORMS: NONE

OMB NO: 0990-0291    EXPIRATION DATE: 09/30/2008
RESPS:83,000         HOURS:41,500         COSTS(000):$0
  Adolescent Family Life Pregnancy Prevention Core Evaluation
FORMS: NONE

OMB NO: 0990-0292    EXPIRATION DATE: 10/31/2008
RESPS:8,448          HOURS:2,112          COSTS(000):$0
  Burn Bed Enumeration
FORMS: NONE

OMB NO: 0990-0294    EXPIRATION DATE: 03/31/2009
RESPS:776,224,162    HOURS:2,210,715      COSTS(000):$0
  Standards for Privacy of Individually Identifiable Health
  Information and Supporting Regulations at 45 CFR Parts 160 and
  164
FORMS: NONE

OMB NO: 0990-0295    EXPIRATION DATE: 01/31/2009
RESPS:845            HOURS:453            COSTS(000):$0
  Survey of Frontline Supervisors of Direct Service Workers
  Participating in the Better Jobs Better Care Demonstration
FORMS: NONE

OMB NO: 0990-0296    EXPIRATION DATE: 02/28/2009
RESPS:390            HOURS:98             COSTS(000):$0
  National Community Centers of Excellence in Women's Health and
  National Centers of Excellence in Women's Health Joint Project
  Evaluation/Participant Survey
FORMS: NONE

OMB NO: 0990-0297    EXPIRATION DATE: 02/28/2009
RESPS:170            HOURS:43             COSTS(000):$0
  National Community Centers of Excellence in Women's Health and
  National Centers of Excellence in Women's Health Joint Project
  Evaluation/Professional/Professional Surveys
FORMS: NONE

OMB NO: 0990-0299    EXPIRATION DATE: 05/31/2009
RESPS:50             HOURS:106            COSTS(000):$0
  Adolescent Family Life Care Demonstration Project End of Year
  Care Template (EOYC)
FORMS: NONE

OMB NO: 0990-0300    EXPIRATION DATE: 05/31/2009
RESPS:60             HOURS:65             COSTS(000):$0
  Adolescent Family Life Prevention Demonstration Project End of
  Year Template
FORMS: NONE

OMB NO: 0990-0302    EXPIRATION DATE: 06/30/2009
RESPS:2,700          HOURS:2,700          COSTS(000):$0
  Medical Reserve Corps (MRC) Unit Profile and Reports
FORMS: NONE

OMB NO: 0990-0303    EXPIRATION DATE: 07/31/2009
RESPS:2,800          HOURS:700            COSTS(000):$0
  National Women's Health Week (NWHW) Survey
FORMS: NONE

OMB NO: 0990-0304    EXPIRATION DATE: 10/31/2006
RESPS:5,790          HOURS:3,785          COSTS(000):$0
  National Outcomes Performance Assessment of the Collaborative
  Initiative to Help End Chronic Homelessness
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
44 777,466,054 4,761,412 $1,186
Office of Family Assistance
OMB NO: 0992-0003    EXPIRATION DATE: 04/30/2009
RESPS:41,300         HOURS:998            COSTS(000):$0
  April 2006 Current Population Survey Supplement on Child Support
FORMS: NONE

OMB NO: 0992-0005    EXPIRATION DATE: 04/30/2008
RESPS:260            HOURS:5,751          COSTS(000):$0
  45 CFR Part 95, Subpart F--Automatic Data Processing Equipment &
  Services--Condition for Federal Financial Participation
FORMS: NONE

OMB NO: 0992-0007    EXPIRATION DATE: 05/31/2008
RESPS:216            HOURS:4,320          COSTS(000):$0
  TANF High Performance Bonus Report, Assessment of Medicaid and
  SCHIP Enrollment Aming Individuals After Leaving TANF Assistance
FORMS: ACF-210

OMB NO: 0992-0008    EXPIRATION DATE: 12/31/2007
RESPS:1,120          HOURS:2,547          COSTS(000):$0
  Survey of Early Head Start Programs
FORMS: NONE

SUBAGENCY TOTALS

ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
4 42,896 13,616 $0

AGENCY TOTALS:


ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
952 8,602,796,386 655,499,763 $1,014,642
(RETURN TO AGENCY LIST)