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State Plan Certification Form And State Health Plan Budget

IC 112199 under ICR 197608-0937-001 · OMB 0937-0009.

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Information Collection (IC) Details

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STATE PLAN CERTIFICATION FORM AND STATE HEALTH PLAN BUDGET
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 5153-1 No No
Form 5153-2 No No


    

335 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 335 0 0 335 0 0
Annual IC Time Burden (Hours) 8,200 0 0 8,200 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.