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Record Of State And Local Action Under Section 1122 Of The Social Security Act
RECORD OF STATE AND LOCAL ACTION UNDER SECTION 1122 OF THE SOCIAL SECURITY ACT
OMB: 0935-0003
IC ID: 112062
OMB.report
HHS/AHRQ
OMB 0935-0003
ICR 197811-0935-002
IC 112062
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0003 can be found here:
1982-12-29 - Revision of a currently approved collection
1982-03-30 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
RECORD OF STATE AND LOCAL ACTION UNDER SECTION 1122 OF THE SOCIAL SECURITY ACT
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HRA-45
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5,250
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
5,250
0
0
5,250
0
0
Annual IC Time Burden (Hours)
2,100
0
0
2,100
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.